JJID: Evaluating The Mortality Risks Of Taking NSAIDs & ASA With Influenza

Photo Credit –CDC PHIL

 

#10,409

 

Readers with long memories will recall that a series of reports emerged five or six years ago questioning the conventional wisdom of taking antipyretics (NSAIDs, acetaminophen, or aspirin) for influenza. 

 

• In 2010’s s A Hot Topic For Further Research we saw a retrospective analysis in the Journal of the Royal Society of Medicine showing the risk of mortality increased by roughly 33% when antipyretics (aspirin, paracetamol, and diclofenac) were used in influenza infected (non-human) animals. 
• A year later, in A Feverish Debate, the well respectedWellington based Medical Research Institute of New Zealand, published a paper (Antipyretic therapy for influenza infection—benefit or harm?) in the New Zealand Medical Journal that questioned the conventional wisdom of using these drugs with influenza.
• Also from 2011 - the American Academy of Pediatrics (AAP) released a report on the use of antipyretics in children, suggesting that we ought not over-treat fevers (Clinical Report—Fever and Antipyretic Use in Children)
• And in 2013,  in Adding To A Feverish Debate, we looked at a study in the Journal of Pediatrics on another possible (albeit, rare) adverse effect seen in a small number of young children with fever and dehydration at a hospital in Indiana who received treatment with NSAIDs -  AKI or Acute Kidney Injury.

 

Somewhat related to all of this have been studies suggesting that  the concurrent use of antipyretics may inhibit the immune response when receiving vaccines (see Anti-Inflammatory Meds And Vaccines and Common Pain Relievers May Dampen Vaccination Benefits).

 

While none of these studies provided definitive proof of harm, they (and others) have raised some interesting questions.

 

Today we’ve a study in the JJID (Japanese Journal of Infectious Diseases) that while subject to a number of limitations, and far from being the last word, should provide some reassurance on the use of antipyretic drugs with influenza.

 

Nonsteroidal Anti-inflammatory Drugs, Aspirin, and Mortality Among Critically Ill Pandemic H1N1 Influenza Patients: An Exploratory Analysis

Holly Epperly, Frances L. Vaughn, Andrew D. Mosholder, Elizabeth M. Maloney, Lewis Rubinson

[Advance Publication] Released: August 07, 2015

Jpn J Infect Dis. 2015 Aug 7. [Epub ahead of print]

Abstract

We explored NSAID and aspirin use and mortality in the U.S. Department of Health and Human Services' registry of 683 adult and 838 pediatric critically ill pandemic 2009 H1N1 influenza (pH1N1) patients.

Among adults, 88 (12.9%) reported pre-admission use of an NSAID, and 101 (14.8%) ASA use; mortality was similar (23-24%) with or without NSAID or ASA use. Mortality among 89 pediatric NSAID users and 749 nonusers did not differ significantly (10.1% and 8.8%, respectively). One of 16 pediatric ASA users died.

Among pediatric patients, the adjusted relative risk estimate for NSAID use and 90-day mortality was higher when influenza vaccination was included in the model (RR= 1.51; 95% CI 0.7-3.2), though not statistically significant. Among adults, RR estimates did not change appreciably after adjusting for age, sex, health status, or vaccine status.

We found no compelling evidence that NSAID or ASA use influenced mortality in severe pH1N1.

 

The full report is available in an Advanced Published PDF file.

 

The authors describe a number of limitations to their analysis, including possible confounding effects of statin use among adults, the small number of pediatric cases using aspirin, the overwhelming use of ibuprofen as the NSAID of choice in the study, and an inability to differentiate between antipyretic and cardioprotective (low dose) aspirin use in adults.