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Old 2020-04-11, 19:13   #583
ewmayer
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Sep 2002
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By way of followup to the ibuprofen-related discussion ack on page 19 of the thread:

Coronavirus Research Done Too Fast Is Testing Publishing Safeguards, Bad Science Is Getting Through | naked capitalism
Quote:
Nothing better illustrates how trusted institutions can make misinformed recommendations than the recent fiasco over ibuprofen.

The most common early symptom of COVID-19 is fever, and ibuprofen is one of the most widely used drugs in the world to treat fever. In a letter published in The Lancet Respiratory Medicine, European researchers raised concerns that ibuprofen use could worsen COVID-19 symptoms. The idea is that since ibuprofen increases the quantity of ACE2 in human cells – the protein that the coronavirus uses to enter lung cells – the virus could infect lung cells more easily if a person was on ibuprofen. This was not a study nor did it present sufficient experimental evidence; it was simply a theoretical concern based on a mechanism.

Three days after the letter was published, the French health minister tweeted a message urging people to avoid ibuprofen for coronavirus associated fever based on four “cited” cases of people getting sicker after taking ibuprofen. These cases were never published in a journal. The French Health Ministry followed this with a broad ban on treating COVID-19 fever with nonsteroidal anti-inflammatory drugs like ibuprofen. The WHO tweeted an essentially similar warning. The media followed with more case anecdotes, dubiously relating worsening early symptoms with ibuprofen use and referring to the letter as a “study,” adding to the confusion and fear.

The Lancet letter also hypothesized that two other drugs commonly used to treat hypertension and diabetes – ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) – could be problematic in people with COVID-19. However, the mechanism they put forward was incompletely described and neglected that a protein these drugs promote can be helpful in reducing inflammation and tissue damage in the lungs and heart.

The Response

This letter to The Lancet slipped past the safeguards in research and institutional and media interpretation, but one of science’s oldest pastimes – definitively calling out the errors of others – reestablished patience and perspective.

Clinicians and scientists pushed back swiftly, supporting the use of ibuprofen in COVID-19 patients. The support was outlined in a published literature review. In response, the WHO quickly reversed its position on ibuprofen.

There was a similar rapid response to the statements about ARBs. Within days, three prominent cardiology groups, including the American Heart Association, released a joint statement urging practitioners not to discontinue ACE-I and ARBs in their patients.

The risk-benefit ratio is always a clinical factor for the use of any drug in any patient. But the risk must be more than theory for the use of a drug to be discontinued or any major policy change to be implemented.

Some Perspective

As the coronavirus rampages across the U.S., it is incredibly important to know whether commonly used drugs like ibuprofen or ARBs are risky, neutral or of therapeutic potential. There are ways to find out quickly. Researchers can look for correlations between the use of ibuprofen or ARBs and more severe infections or deaths, for example. And standard clinical trials can, should and are being done. There are several studies currently underway testing the effect and risk of ARBs for COVID-19 patients. But until the science is finished, it is foolish and potentially dangerous to flee from tested clinically important drugs.

Last fiddled with by ewmayer on 2020-04-11 at 19:15
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