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ACEIs, ARBs, Ibuprofen and COVID-19 infection: Dr. Anant Patil

M3 India newsdesk Mar 20, 2020

Dr. Anant Patil throws light on the ongoing discussion about the use of certain drugs in the context of COVID-19, Ibuprofen being one of them.


For our comprehensive coverage and latest updates on COVID-19 click here.


After the outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2), also known as Coronavirus disease (COVID-19) which started in  December 2019, in Wuhan, China and subsequently spread worldwide, there is an ongoing discussion about the use of two important classes of drugs used for hypertension i.e. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) and another drug ibuprofen used for the treatment of pain and inflammation.

Studies [1,2,3] from China have shown cerebrovascular disease, hypertension, and diabetes to be common comorbidities in patients with severe SARS-CoV-2 disease. The use of angiotensin-converting enzyme inhibitors (ACEIs) is common in the treatment of these comorbidities. It has been suggested that SARS-CoV-2 binds to target cells through angiotensin-converting enzyme 2 (ACE2) [4] and ACE2 expression can be increased by ACEIs, ARBs, thiazolidinediones, and ibuprofen. [5]

Considering these hypotheses, increased expression of ACE2 can result in the facilitation of infection with COVID-19 in patients using these medicines. Authors of an article [5] suggested that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2- increasing drugs, are at higher risk for developing severe COVID-19 infection. Needless to say, this raised concern among physicians prescribing and patients taking these drugs. According to another hypothesis, the use of ARB may be able to control the spread of the novel coronavirus (Wuhan) infection. [6]


After understanding the concerns, several international organizations/associations have clarified their stand regarding the use of ACEIs and ARBs for the treatment of hypertension in the context of COVID-19 infection.

According to the Council on Hypertension of the European Society of Cardiology (ESC), [7] there is no evidence that supports the harmful effects of ACEIs and ARBs in the context of COVID-19. In the absence of clinical or scientific evidence suggesting a need for discontinuation of ACEIs or ARBs, the council on hypertension has strongly recommended continuing usual anti-hypertensive treatment

Similarly, the International Society of Hypertension (ISH) [8] also endorsed the absence of good evidence to change the use of ACE-inhibitors or ARBs for the management of hypertension in the context of COVID-19 infection. In the absence of compelling evidence, ISH strongly recommended continuing ACE-Inhibitors or ARBs for the treatment of hypertension.

According to the statement from the American Heart Association (AHA), the Heart Failure Society of America (HFSA) and the American College of Cardiology (ACC), [9] patients who are already prescribed ACEI or ARB for indications such as heart failure, hypertension or ischaemic heart disease should continue taking these medications, unless otherwise advised by their physician.

Overall, the data shows that currently, there is no strong clinical evidence which suggests that ACEIs or ARBs can increase the risk of complication in the context of COVID-19 infection.


Use of ibuprofen in the context of COVID-19 infection

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID) is another drug in discussion in the context of COVID-19 infection. Ibuprofen is also postulated to exacerbate the COVID-19 infection. [10] According to an article, [10] ibuprofen should not be used for managing symptoms. Some doctors/researchers recommend using paracetamol in patients showing symptoms of COVID-19 instead of ibuprofen. However, at the moment, there is no strong scientific evidence to support linking NSAIDs with the severity of COVID-19. [11]

On March 18, 2020, the European Medicine Agency (EMA) [12] endorsed that there is currently no scientific evidence showing a link between ibuprofen and the worsening of COVID-19. All available options (including paracetamol and NSAIDs) should be considered while starting treatment for fever or pain in patients with COVID-19. Patients should contact their treating physicians, in case of any questions. The WHO also doesn’t recommend avoiding it for COVID-19 symptoms. [13]


Click here to see references

 

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Anant Patil is Assistant Professor of Pharmacology.

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