The largest clinical review of immune response to non-steroidal anti-inflammatory drugs, opioid analgesics, paracetamol (acetaminophen) has provided insight into the unintended effects of these commonly used medications, according to new study results.

The findings highlight the potential of some of these medications to be used to treat new and old infectious diseases.

The impact of these medications’ effects on infectious disease were unclear, because of the amount of research on the effects they had for fever management and pain. The findings of the clinical review suggest the need for more studies on this underrecognized area of research.

Investigators found that morphine was able to suppress key cells of the immune system and increase the risk of infection, particularly after cancer surgery.

Additionally, antipyretics, such as acetaminophen, aspirin, and ibuprofen, can reduce the desirable immune response when taken after a vaccination. Aspirin can also be an accessible and affordable therapeutic option for tuberculosis, which mainly affects poor countries, and it has also shown beneficial results in animals and humans.

Furthermore, indomethacin, an anti-inflammatory medication, has the potential to reduce viral replication of COVID-19, but large-scale human trials are needed to investigate this claim.

The investigators were from the Faculty of Medicine and Health at the University of Sydney. They opted for a clinical review to have a broader scope of available evidence to analyze, which shows the importance of further research and trials to study infectious disease responses.

The research, according to lead author, Christina Abdel-Shaheed, PhD, was unplanned, and the findings were unexpected.

The investigators said that they were initially interested in studying the possible impacts of acetaminophen during the pandemic.

“Our review shows some of the common pain and fever medications may work with the immune system to fight infection, whereas others work against it and increase the risk of contracting or responding badly to infectious diseases,” Abdel-Shaheed said.

Investigators highlighted the findings around morphine, especially since those individuals with cancer are more immunocompromised.

It is important to achieve adequate analgesia while avoiding immunosuppression, investigators said.

However, the findings shed a positive light on insight for these commonly used medications. Further research could be used to evaluate these medications and show how they can be repurposed to improve outcomes for individuals undergoing treatment for infectious diseases.

The results should be used to explore these inexpensive adjunctive treatments that could influence immune and inflammation pathways, investigators said.

“With the urgent need for new treatments for COVID-19 and the declining efficacy of some antimicrobial agents due to resistance, now more than ever we need medicines which can maintain or enhance the efficacy of anti-infective drug treatments,” Andrew McLachlan, the head of school and dean of Pharmacy at the University of Sydney, said in the statement.

Other studies should be conducted to fully understand the effects of these medications on the immune system, especially since the area has been underrecognized, investigators said.

The study findings were published in the British Journal of Clinical Pharmacology.

Reference

Are medicines affecting our response to infections like COVID-19? EurekAlert. News release. March 1, 2022. Accessed March 3, 2022. https://www.eurekalert.org/news-releases/944906