Chronic Liver Disease or Cirrhotic Patients Infected with SARS-CoV-2 Benefited from the Usual Oral Selective COX-2 Inhibitor

Background: The interdependent impacts between chronic liver disease (CLD) or cirrhosis and the common cold can deteriorate both of them due to the usual mild systemic inflammation. This retrospective study aimed to evaluate the effects of the usual oral cyclooxygenase-2 (COX-2) inhibitors on patients with CLD/cirrhosis.Methods: The patients with prolonged intermittent oral selective COX-2 inhibitors (any of celecoxib, imrecoxib, etoricoxib) for more than three months due to osteoarthritis (OA) or rheumatoid arthritis (RA) were included in the COX-2-I cohort, and the non-COX-2 inhibitor users were included in the control cohort. The primary outcome was the occurrence of acute decompensation (AD) events or severe/critical COVID-19.Findings: Compared to the control cohort, the occurrence of severe/critical COVID-19 in the COX-2-I cohort significantly decreased by 96.7% (p=0.002). No CLD/cirrhotic patient in the COX-2-I cohort suffered from respiratory failure, AD events, acute-on-chronic liver failure (ACLF) or died from COVID-19. The usual oral selective COX-2 inhibitors not only significantly decreased hospital admissions but also reduced the demand forintensive care unit (ICU) (p<0.05). The occurrence (57.26% vs 83.52%, p<0.001; 42.74% vs 69.22%, p<0.001) and duration (6.29 ± 3.94 days vs 8.26 ± 4.23 days, p<0.001; 1.94 ± 1.04 days vs 2.71 ± 1.94 days, p=0.016) of cough or fever in the COX-2-I cohort were significantly lower or shorter than those in the control cohort. No patients experienced major adverse reactions when often taking selective COX-2 inhibitors at a low dose.Interpretation: The usual oral administration of low-dose COX-2 inhibitors was found to be beneficial for CLD/cirrhotic patients in alleviating the symptoms of COVID-19, reducing AD events and ACLF, as well as decreasing hospitalizations and ICU requirements during the SARS-CoV-2 pandemic. This management may also have implications for other colds especially as the Omicron variant continues to mutate.Funding: National Natural Science Fund of China.Declaration of Interest: The authors disclose no conflicts.Ethical Approval: This retrospective study was conducted in West China Hospital from December, 2022 to January 2023 and was approved by the ethics committees of West China hospital (HX2022-1377).