TABLE 2.
Summary of findings: Ibuprofen compared to Placebo/Other NSAIDs for adult ARTI
|
Patient or population: adult ARTI Intervention: Ibuprofen Comparison: Placebo/Other NSAIDs | ||||||
|---|---|---|---|---|---|---|
|
Outcome № of participants (studies) |
Relative effect (95% CI) |
Anticipated absolute effects (95% CI) | Certainty | What happens | ||
| Difference | ||||||
|
Fever № of participants: 535 (2 RCTs) |
– | not pooled | – | not pooled |
⨁⨁⨁⨁ HIGH |
Ibuprofen results in a moderate reduction in fever. |
|
Cough № of participants: 450 (3 RCTs) |
– | not pooled | – | not pooled |
⨁⨁◯◯ LOW a,b,c |
The evidence suggests that ibuprofen results in little to no difference in cough. Use of different, non–uniform variables for cough hinders accumulative reasoning. The little effect shown by Gwaltney et al. may be due to the additional Chlorpheniramine. Winther et al. study results show a paradoxical increase of symptom severity in patients who initially had a mild cough. |
|
Sore Throat № of participants: 355 (4 RCTs) |
– | not pooled | – | not pooled |
⨁⨁◯◯ LOW d,e,f |
Ibuprofen likely results in a reduction in Sore Throat pain. The effect seems to be larger if the pain is more prominent upon presentation. |
|
ARDS (minute‐ventilation) follow up: mean 30 days № of participants: 455 (1 RCT) |
– | The mean ARDS (minute‐ventilation) was 14.13 lit/min | – |
mean 0.92 lit/min lower (0.8453 lower to 0.9947 lower) |
⨁⨁◯◯ LOW g |
Ibuprofen may result in a slight reduction in Oxygen therapy needed for ICU admitted patients with sepsis. it is worthy of note that the initially required oxygen volume is approximately 13 liters in both study arms. |
| Length of Stay ‐ not reported | – | – | – | – | – | No study investigated the efficacy of Ibuprofen in the disease duration of the adult population. |
|
Mortality follow up: mean 30 days № of participants: 455 (1 RCT) |
RR 0.88 (0.69 to 1.10) |
40.3% |
35.4% (27.8 to 44.3) |
4.8% fewer (12.5 fewer to 4 more) |
⨁⨁◯◯ LOW h |
Ibuprofen may result in little to no difference in mortality. |
|
Gastrointestinal Adverse Events (GI upset) № of participants: 1467 (5 RCTs) |
not pooled | 19.9% | not pooled | not pooled |
⨁⨁◯◯ LOW i,j |
Even though the total incidence of adverse events is large, there is considerable variation in the imprecision of results across studies. Overall, the evidence suggests little to no difference in gastrointestinal adverse events in adults in short terms. |
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
Explanations: a. Winther et al. study resulted in an increase in cough severity score, whereas Gwaltney et al. reported a minor decrease in symptom severity. Llor et al. reported a decrease in symptom duration; b. Gwaltney et al. used Chlorpheniramine along with Ibuprofen; c. Llor et al. reported symptom duration rather than symptom severity d. Bouroubi et al. demonstrated a moderate alleviating effect, whereas Gwaltney et al. showed a small effect size. Meanwhile, Sperber et al. concluded a mixed effect that may be due to its relatively smaller sample size. Winther et al. reported a mildly worsening effect probably due to initial selection bias; e. Gwaltney et al. uses concomitant chlorpheniramine. Sperber et al. uses concomitant pseudoephedrine; f. One study by Sperber et al. resulted in a variable effect due to the small sample size; g. Bernard et al. measured minute‐ventilation in sepsis patients of varied etiology including but not confined to pneumonia; h. Bernard et al. recorded 30‐day mortality in sepsis patients of varied etiology including but not confined to pneumonia; i. In Adults: Sperber et al., and Bernard et al report a protective RR, whereas Little et al., Llor et al., and Bouroubi et al. report a harmful RR and j. Most calculated 95% confidence intervals for RRs are extremely wide. Sperber et al. had a small sample size.
Abbreviations: CI, Confidence interval; RR, Risk ratio.
The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).