United Kingdom

Could ibuprofen treat severe cases of Covid-19? Doctors launch trial

Doctors in London are launching a trial to determine whether ibuprofen could treat severe cases of Covid-19 and save thousands of lives. 

Experts hope a special formula that contains the cheap painkiller will prevent life-threatening breathing problems that coronavirus patients can suffer.

This could lead to infected patients spending less time in hospital and avoid being sent to intensive care or needing ventilation. 

Studies on animals with severe respiratory illness - which can be caused by Covid-19 - have shown ibuprofen can boost survival rates by up to 300 per cent. 

Researchers said the findings are 'very promising' and they 'want to translate that really compelling result into humans'.

It follows controversy early on in the pandemic over fears the anti-inflammatory may actually make Covid-19 worse for those with mild symptoms.

The NHS removed advice to take ibuprofen for the coronavirus off its website amid fears over the safety of the drug, which can be bought for pennies.

But a review of 13 scientific studies of the effects of anti-inflammatory drugs, such as ibuprofen, found no evidence for or against using it. 

Doctors in London are launching a trial to see if ibuprofen could treat severe cases of Covid-19 and save live

Now researchers from the same group that suggested ibuprofen is safe for Covid-19 - London’s Guy’s and St Thomas’ NHS Foundation Trust and King’s College London - are seeing if it can even help cure the disease. 

The LIBERATE trial, which started at the end of May, is being conducted with the pharmaceutical organisation the SEEK Group. 

The drug is a unique formulation of ibuprofen, that is already licensed for use in the UK, but is very different to what's available to buy over the counter. 

Half of the 230 hospitalised patients enrolled in the trial will receive standard care, which tends to revolve around giving them more oxygen.

The other half will receive standard care plus the special ibuprofen formulation, in the hope it will avoid aggressive treatment further down the line. 

Doctors will assess whether the drug can reduce a serious side effect seen among patients infected called acute respiratory distress syndrome (ARDS). 

WHY DID EXPERTS SAY IBUPROFEN COULD WORSEN CORONAVIRUS SYMPTOMS?  

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation, and is used to decrease pain or a fever.

Scientists say there’s no clear evidence that ibuprofen makes COVID-19 worse, but there were fears this was the case at the early stage of the pandemic. This is why: 

Professor Paul Little, primary care research, University of Southampton, said: 'There is now a sizeable literature from case control studies in several countries that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used.'

Experts say paracetamol should be a first choice because:

1. Ibuprofen may dampen the body's immune response to infection because it is has anti-inflammatory effects. This may slow the recovery process, Professor Ian Jones, a virologist at the University of Reading, said.

2. He added that it is likely the coronavirus acts in a similar way to SARS, in that it reduces an enzyme which regulates salt and water in the blood. This can lead it pneumonia. Ibuprofen may aggravate this, Professor Jones said.

2. NSAIDs can cause stomach irritation and stress on the kidneys if taken over a long period of time. This could be exacerbated in those who already have kidney or stomach problems brought on by severe illness, such as COVID-19, experts said.  

ARDS - when the lungs become severely inflamed - can kill. Many patients affected are unable to breathe by themselves and need to be put on a ventilator.  

If it can be avoided, it could mean fewer patients end up on ventilation, which doctors prefer to avoid at all costs due to the potential long term damage.   

Mitul Mehta, professor of neuroimaging and psychopharmacology at Kings College London, said: 'It's a trial for patients with Covid-19 disease to see if giving them an anti-inflammatory drug - a specific form of ibuprofen - will reduce the respiratory problems they have.'

He stressed that the trial was for hospitalised patients - not those who have mild or suspected Covid-19.

Participants will be drawn from those who are hospitalised, but not so ill they are in need of intensive care.

Professor Mehta added: 'And if we can reduce their symptoms at that stage we have a number of benefits: we could reduce the amount of time that someone spends in hospital - they might recover quicker and go home, that's obviously a fantastic outcome; we also might be reducing the degree of respiratory distress so that it can be managed in the hospital setting, without needing to go to ICU. And that is a fantastic outcome as well.

'Theoretically, this treatment, given at this time, should be beneficial.

'But of course, this is based on animal studies. It's based on case reports, we need to do a trial to show that the evidence actually matches what we expect to happen.'

Professor Mehta said that animal studies into acute respiratory distress syndrome - a complication of Covid-19 disease - shows that around 80 per cent of animals with this condition die.

But when they are given this special formulation of ibuprofen the survival rates increase to 80 per cent - a four-fold improvement. 

'This is very promising,' he said. 'But of course it is an animal study, so we want to translate that really compelling result into humans.'  

It is hoped that the way the drug has been formulated will reduce potential gastric side effects linked to ibuprofen.

Professor Matthew Hotopf, director of the NIHR Maudsley Biomedical Research Centre said: 'This highly innovative therapeutic approach seeks to rapidly advance a potentially important new treatment. 

'If successful, the global public health value of this trial result would be immense given the low cost and availability of this medicine.'

Lab-based experiments performed by the SEEK Group show the drug was more effective than standard ibuprofen for treating ARDS.   

Early on in the pandemic, there was controversy over the use of ibuprofen after a French health minister advised against the use of it.

French health minister Olivier Véran, a qualified doctor and neurologist, raised high profile concerns about anti-inflammatories with a tweet on March 14.

He said: 'Taking anti-inflammatory drugs could be an aggravating factor of the infection. If you have a fever, take paracetamol.'

At that point, the NHS guidance for anyone self-isolating with Covid-19 symptoms was to medicate with paracetamol and ibuprofen.

Ibuprofen is widely taken to relieve pain as well as reduce a fever and aches caused by common colds and flu. 

The concerns prompted Number 10's chief scientific adviser, Sir Patrick Vallance, to say the 'sensible thing to do' would be to not take ibuprofen until the science becomes clearer. 

Scientists at King's College London launched a review to assess non-steroidal anti-inflammatory drugs (NSAIDs) affect the body's immune system. 

The team scoured studies that related to Covid-19 and published their review in the journal ecancermedicalscience.

The team wrote: 'Our search did not identify any strong evidence for or against the use of ibuprofen for treatment of COVID-19 specifically.

'The current literature does not give conclusive evidence for or against the use of NSAIDs in the treatment of COVID-19 patients.'

Cancer and transplant patients have a higher risk of developing severe Covid-19 complications, especially as they may be treated with drugs that stop their immune system working properly. 

If these patients catch the coronavirus, their doctors need to know what medications to stop giving them in order to stop their disease becoming severe.   

The Commission on Human Medicines' expert working group concluded: 'There is currently insufficient evidence to establish a link between use of ibuprofen and susceptibility to contracting Covid-19 or the worsening of its symptoms.'

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