NSAIDs – such as Advil and Meloxicam – may aggravate or suppress COVID-19 depending on timing

New research shows that non-steroidal anti-inflammatory drugs (NSAIDs) have reduced both antibodies and inflammatory responses EARS-CoV-2 infection in mice. The study appears this week in the Journal of Virology, a publication of the American Society for Microbiology.

The study is important because “NSAIDs are probably the most anti-inflammatory drugs,” said Craig B. Wilen, assistant professor of laboratory medicine and immunology. Yale University School of Medicine.

In addition to using NSAIDs for chronic conditions such as arthritis, people take them “for shorter periods during infections, and [during] acute inflammation as experienced with COVID-19, and for side effects of vaccination, such as soreness, fever and malaise, ”said dr. Wilen said. “Our work suggests that the NSAID meloxicam attenuates the immune response to SARS-CoV-2 infection.”

The research also suggests that the effects of using NSAIDs during natural infection and vaccination in humans should be assessed, said Dr. Wilen said. “These data probably exist, especially in the clinical trials for the vaccines, and should therefore be exploited to determine whether they elicit antibody responses in humans.”

“Taking NSAIDs during COVID-19 can be harmful or beneficial, depending on the time of administration,” said Dr. The powerful anti-inflammatory, dexamethasone (not an NSAID), is detrimental to COVID-19 sufferers when taken early in the infection, but is beneficial when administered during later stages of COVID-19, Drs.

Similarly, the anti-inflammatory activity of NSAIDs early in the SARS-CoV-2 infection may be detrimental because at this stage, inflammation is usually helpful. This changes in later stages of COVID-19, especially if the patient is experiencing intense inflammation, known as a cytokine storm. A cytokine storm is an immune response of inflammatory compounds that is common in COVID-19 patients, which can lead to complications, the need for the intensive care unit and even death.

The reduction of neutralizing antibodies caused by NSAIDs may be benign, or it may blunt the immune system’s ability to fight the disease, in the early stages of the infection. It can also reduce the extent and / or length of protection against natural infection or vaccination, said dr. Wilen said.

The initial motivation for investigating the effects of NSAIDs on COVID-19 was a twitter thread, which indicates that NSAIDs should not be used during COVID-19, ‘said Dr. Wilen said. “It seemed suspicious to us, so we wanted to investigate.”

Dr. Wilen and his team expected the NSAIDs to have little or no effect on viral infection, which appears to be correct. They also thought that NSAIDs would not affect the antibody response to natural infection. ‘In fact, at first we did not even look at the antibody response thoroughly, because we did not expect it to be altered by NSAIDs. This seems to be wrong, said dr. Wilen said.

Reference: “Non-steroidal anti-inflammatory drugs dampen cytokine and antibody response to SARS-CoV-2 infection” by Jennifer S. Chen, Mia Madel Alfajaro, Ryan D. Chow, Jin Wei, Renata B. Filler, Stephanie C Eisenbarth and Craig B. Wilen, January 19, 2021, Journal of Virology.
DOI: 10.1128 / JVI.00014-21

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