Relative effectiveness and gastrointestinal safety of NSAIDs being prescribed for upper respiratory tract infections: an explorative cohort study in primary care

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to control pain, inflammation, and fever in upper respiratory tract infections (URTIs).AimTo explore the relative effectiveness and gastrointestinal (GI)-related safety of individual NSAIDs to control symptoms of URTIs.MethodUsing an Italian primary care data source, we identified patients aged >= 15 years who were newly prescribed NSAIDs for URTIs between 2013 and 2022. Switching to another NSAID for the same indication within the 30-day follow-up was a proxy for drug effectiveness. The study outcome for GI safety analysis was upper gastrointestinal bleeding (UGIB).ResultsIn a cohort of 57,971 patients, the most prevalent subgroups were those treated with ketoprofen (39.5%) and dexibuprofen/ibuprofen (22.4%). Ketoprofen showed the lowest rate of switching to another NSAID [Hazard Ratio (HR) 0.40 (95% CI 0.20-0.83)] against acetylsalicylic acid/coxibs/diclofenac. Dexibuprofen/ibuprofen showed similar results [HR 0.50 (95% CI 0.22-1.10)], with no significant association. Ketoprofen and dexibuprofen/ibuprofen were prescribed as lysine and arginine salts in 85 and 6% of URTIs sufferers, respectively. Across NSAIDs, we did not find any significant difference in the risk of UGIB.ConclusionOur findings indicated that various NSAIDs may exhibit differing levels of effectiveness in treating URTIs, particularly those formulated for quick onset of action. No NSAIDs-UGIBs association was found. Further prospective, larger studies are needed to confirm these findings.