Long‐term intermittent oral administration of selective COX‐2 inhibitor improved the clinical outcomes of COVID‐19 in patients with cirrhosis

Objectives Patients with cirrhosis are more susceptible to coronavirus disease 2019 (COVID‐19) due to immune dysfunction. In this retrospective study we aimed to investigate whether suppression of mild systemic inflammation with selective cyclooxygenase‐2 inhibitor (COX‐2‐I) during chronic care of cirrhotic patients would reduce the occurrence of acute decompensated events and improve patient prognosis of COVID‐19. Methods Medical records of cirrhotic patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection were sequentially reviewed. The patients were divided into the COX‐2‐I and control groups depending on whether they took oral selective COX‐2‐I for over 3 months or not. The primary outcomes included the occurrence of severe/critical COVID‐19, acute decompensated events, and acute‐on‐chronic liver failure (ACLF). Results After propensity score matching analysis, there were 314 cases in the control group and 118 cases in the COX‐2‐I group. Compared with the control group, the risk of severe/critical COVID‐19 in the COX‐2‐I group was significantly decreased by 83.1% (p = 0.004). Acute decompensated events and ACLF occurred in 23 (7.32%) and nine (2.87%) cases in the control group, but none in the COX‐2‐I group (p = 0.003 and 0.122). The rate of hospitalization in the COX‐2‐I group was significantly lower than that of the control group (3.39% vs 13.06%, p = 0.003). No patient in the COX‐2‐I group required intensive care unit admission. Conclusions Long‐term intermittent oral administration of selective COX‐2‐I in cirrhotic patients significantly reduces the occurrence of severe/critical COVID‐19, acute decompensated events, and ACLF. It may also be used for systemic inflammation caused by other pathogens. Long‐term intermittent oral administration of a selective cyclooxygenase‐2 inhibitor (COX‐2‐I) for cirrhotic patients significantly decreased the occurrence of severe/critical coronavirus disease 2019 (COVID‐19), acute decompensated events, and acute‐on‐chronic liver failure (ACLF), as well as the symptoms of COVID‐19. The hospitalization and intensive care unit (ICU) admission were therefore reduced. SAR‐S‐CoV‐2, severe acute respiratory syndrome coronavirus 2.