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Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists

BMJ 2020; 368 doi: (Published 17 March 2020) Cite this as: BMJ 2020;368:m1086

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COVID-19: learning from the claim data of those who were severely affected but also from their asymptomatic household members

Dear Editor

The Italian National Health Service (Istituto Superiore di Sanita) regularly publishes the latest updates on the characteristics of COVID-19 infected patients who died in Italy. The most common pre-existing chronic condition, diagnosed prior to contracting the infection, has been cardiovascular diseases (76.5% hypertension, 37.3% ischemic heart disease and 26.5% atrial fibrillation).[1] By studying the medication profile of those who were severely affected by COVID-19 or died we might be able to address questions like whether Angiotensin Converting Enzyme Inhibitors (ACE inhibitors), Angiotensin Receptor Blockers (ARBs) [2] or ibuprofen are safe in these patients. A comparison of the medical history with those who were either asymptomatic or showed mild symptoms can further define the profiles of those who are more at risk.

From the start of the COVID-19 outbreak the number of clinical trials for repurposing existing drugs in managing the infection has been rapidly increasing. Currently 66 interventional clinical trials with compounds exhibiting various modes of action have been submitted to, including antiviral, anti-inflammatory and immunomodulatory regimens. Some of the compounds are widely used for other indications.[3]

In Italy and similarly affected countries, the existing claim data may provide valuable information for discovering potentially effective treatments. A comprehensive study of the medication used by the patients prior to contracting COVID-19, but also the medication used by their household members that were never referred to a hospital in that period (because they were asymptomatic or had mild symptoms), may help to identify potentially effective compounds for future studies. Using a specific and accurate diagnosis code for COVID-19 in the claim records will facilitate such research.

1. Istituto Superiore di Sanità. Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia Il presente report è basato sui dati aggiornati al 13 Marzo 2020. (accessed 17 Mar 2020).
2. Zheng Y-Y, Ma Y-T, Zhang J-Y, et al. COVID-19 and the cardiovascular system. Nature Reviews Cardiology Published Online First: 2020. doi:10.1038/s41569-020-0360-5
3. (accessed 17 Mar 2020).

Competing interests: No competing interests

17 March 2020
Sahar Barjesteh van Waalwijk van Doorn-Khosrovani (PharmD-PhD)
Anke Pisters- van Roy (MD)
Tilburg, The Netherlands