Diclofenac and Ibuprofen in Patients with Chronic Liver Disease and Liver Cirrhosis

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed medications around the world. Also, they are one of the top sources of drug-induced liver injuries. Several reports studied the effects of Aspirin, but reports on other NSAIDs are widely lacking. Therefore, the aim of our retrospective study was to analyze the effects of diclofenac and ibuprofen administration in patients with chronic liver disease from two large cohorts in South Korea and the United States. We analyzed data from men and women diagnosed with different chronic liver disease (CLD) subgroups. Liver Cirrhosis (LC) 32366 patients, Nonalcoholic Liver Disease (NLD) 27444 patients, Chronic Viral hepatitis B and C (CNV) 21046 patients, and Autoimmune Liver Disease 2728 patients). Investigating the use of diclofenac and ibuprofen did not lead to any disadvantage in survival for Asian patients (LC, p<0.001). Results from the US cohort may even suggest a benefit of these drugs in most patients with chronic liver disease (LC, p<0.001; NLD p<0.001; CVH, p<0.001). However, for Asian patients with chronic viral hepatitis and documented use of either one of these drugs we observed a decreased overall survival (OS) over 15 years (p<0.05). The reasons for the special susceptibility of this population need to be further investigated. With the exception of Asian patients with chronic viral hepatitis B and C, our large cohort data suggests that the use of diclofenac and ibuprofen in patients with chronic liver disease may generally be safe.