Please use this identifier to cite or link to this item: https://doi.org/10.1002/cti2.1159
Title: Safety and potential efficacy of cyclooxygenase-2 inhibitors in coronavirus disease 2019
Authors: Ong, S.W.X.
Tan, W.Y.T.
Chan, Y.-H.
Fong, S.-W. 
Renia, L.
Ng, L.F.P. 
Leo, Y.-S. 
Lye, D.C. 
Young, B.E.
Keywords: COVID-19
COX-2 inhibitors
interleukin-6
SARS-CoV-2
Issue Date: 26-Jul-2020
Publisher: John Wiley and Sons Inc
Citation: Ong, S.W.X., Tan, W.Y.T., Chan, Y.-H., Fong, S.-W., Renia, L., Ng, L.F.P., Leo, Y.-S., Lye, D.C., Young, B.E. (2020-07-26). Safety and potential efficacy of cyclooxygenase-2 inhibitors in coronavirus disease 2019. Clinical and Translational Immunology 9 (7) : e1159. ScholarBank@NUS Repository. https://doi.org/10.1002/cti2.1159
Rights: Attribution-NonCommercial 4.0 International
Abstract: Objectives: While the safety of non-steroidal anti-inflammatory drugs in COVID-19 has been questioned, they may be beneficial given the hyper-inflammatory immune response associated with severe disease. We aimed to assess the safety and potential efficacy of cyclooxygenase-2 (COX-2) selective inhibitors in high-risk patients. Methods: Retrospective study of patients with COVID-19 pneumonia and aged ≥ 50 years who were admitted to hospital. Adverse outcomes analysed included supplemental oxygen use, intensive care unit admission, mechanical ventilation and mortality, with the primary endpoint a composite of any of these. Plasma levels of inflammatory cytokines and chemokines were measured in a subset. Results: Twenty-two of 168 (13.1%) in the cohort received COX-2 inhibitors [median duration 3 days, interquartile range (IQR) 3–4.25]. Median age was 61 (IQR 55–67.75), 44.6% were female, and 72.6% had at least one comorbidity. A lower proportion of patients receiving COX-2 inhibitors met the primary endpoint: 4 (18.2%) versus 57 (39.0%), P = 0.062. This difference was less pronounced after adjusting for baseline difference in age, gender and comorbidities in a multivariate logistic regression model [adjusted odds ratio (AOR) 0.45, 95% CI 0.14–1.46]. The level of interleukin-6 declined after treatment in five of six (83.3%) treatment group patients [compared to 15 of 28 (53.6%) in the control group] with a greater reduction in absolute IL-6 levels (P-value = 0.025). Conclusion: Treatment with COX-2 inhibitors was not associated with an increase in adverse outcomes. Its potential for therapeutic use as an immune modulator warrants further evaluation in a large randomised controlled trial. © 2020 The Authors. Clinical & Translational Immunology published by John Wiley & Sons Australia, Ltd on behalf of Australian and New Zealand Society for Immunology, Inc.
Source Title: Clinical and Translational Immunology
URI: https://scholarbank.nus.edu.sg/handle/10635/198700
ISSN: 20500068
DOI: 10.1002/cti2.1159
Rights: Attribution-NonCommercial 4.0 International
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