"NSAIDs: a double edged sword in viral infections"

    This paper has been accepted for publication in" International Journal of Medical Reviews"

     Accept Date: 19 May 2021

     Romany Helmy. Thabet ^{1, 2}, Haya Abdallah Fandi Omeish ^{3, 5},  Hadeel Fawwaz Anees Abbas ⁵  ,Angam Ayyoub Ali Najadat ^{4, 5},  

      Amer Khaled Abed Al-Hafeez Abu Hameed ⁵ , Hayat Ghaseb Abu Alkhoun ⁵

      ¹Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid-Jordan

      ² Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt

      ³ King Hussein Medical Center

      ⁴ Jordanian royal medical services

      ⁵  Faculty of Medicine, Yarmouk University, Irbid-Jordan

                                                  Names on red are FM/YU medical students and graduates

Abstract

NSAIDs are used as analgesics and antipyretics in viral infections, as supportive therapy is the mainstay of treatment. However, their role in the course of the illness is still ambiguous. Several experimental evidences, done on various viral infections about the role of NSAIDs in the course of illness are contradictory; some reported possible antiviral effects and some negated it. NSAIDs inhibit PGs and also have their own actions on immune system and viruses. NSAIDs have stimulatory effects on T lymphocytes, Nitric oxide and interferons, but inhibitory effects on neutrophils, macrophages and antibodies formation.

NSAIDs are used as adjunctive treatment in infectious diseases in which cytokines storm plays a role in the pathogenicity. However, in other studies their effects on immune system were associated with unresolved symptoms and complications. What is worth saying in this entity is the evidence-based studies of antimicrobial activity of NSAIDs. NSAIDs are proven to inhibit the entry of virus into  cells like in ZIKV, as well as inhibit the replication of many viruses as in the inhibitory effect of naproxen on SARS-CoV-2 replication. However, they fail to show any direct antiviral activity in adenovirus infections, and it was found that Ibuprofen increases the shedding of RSV in a bovine model. Indeed there are many contradictory published studies between various viruses, patients’ cases, and whether they are studies performed on animals or humans.

More randomized clinical trials are mandatory to elucidate  exactly whether the use of NSAIDs, during viral infections ,especially COVID-19, modifies  and aborts the course of viral infection by exerting beneficial therapeutic effects or it’s accompanied by delirious hazards and negatively impact health of the patient.