Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-19

Arthritis Rheumatol. 2021 May;73(5):731-739. doi: 10.1002/art.41593.


Objective: To identify whether active use of nonsteroidal antiinflammatory drugs (NSAIDs) increases susceptibility to developing suspected or confirmed coronavirus disease 2019 (COVID-19) compared to the use of other common analgesics.

Methods: We performed a propensity score-matched cohort study with active comparators, using a large UK primary care data set. The cohort consisted of adult patients age ≥18 years with osteoarthritis (OA) who were followed up from January 30 to July 31, 2020. Patients prescribed an NSAID (excluding topical preparations) were compared to those prescribed either co-codamol (paracetamol and codeine) or co-dydramol (paracetamol and dihydrocodeine). A total of 13,202 patients prescribed NSAIDs were identified, compared to 12,457 patients prescribed the comparator drugs. The primary outcome measure was the documentation of suspected or confirmed COVID-19, and the secondary outcome measure was all-cause mortality.

Results: During follow-up, the incidence rates of suspected/confirmed COVID-19 were 15.4 and 19.9 per 1,000 person-years in the NSAID-exposed group and comparator group, respectively. Adjusted hazard ratios for suspected or confirmed COVID-19 among the unmatched and propensity score-matched OA cohorts, using data from clinical consultations in primary care settings, were 0.82 (95% confidence interval [95% CI] 0.62-1.10) and 0.79 (95% CI 0.57-1.11), respectively, and adjusted hazard ratios for the risk of all-cause mortality were 0.97 (95% CI 0.75-1.27) and 0.85 (95% CI 0.61-1.20), respectively. There was no effect modification by age or sex.

Conclusion: No increase in the risk of suspected or confirmed COVID-19 or mortality was observed among patients with OA in a primary care setting who were prescribed NSAIDs as compared to those who received comparator drugs. These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic.

MeSH terms

  • Acetaminophen / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • COVID-19 / epidemiology*
  • Case-Control Studies
  • Cause of Death
  • Codeine / analogs & derivatives
  • Codeine / therapeutic use
  • Disease Susceptibility
  • Drug Combinations
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mortality*
  • Osteoarthritis / drug therapy*
  • Primary Health Care
  • Propensity Score
  • Proportional Hazards Models
  • Risk Factors
  • SARS-CoV-2
  • United Kingdom / epidemiology


  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Drug Combinations
  • acetaminophen, codeine drug combination
  • Acetaminophen
  • dihydrocodeine
  • Codeine