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Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial.
Lopes, Renato D; Macedo, Ariane V S; de Barros E Silva, Pedro G M; Moll-Bernardes, Renata J; Dos Santos, Tiago M; Mazza, Lilian; Feldman, André; D'Andréa Saba Arruda, Guilherme; de Albuquerque, Denílson C; Camiletti, Angelina S; de Sousa, Andréa S; de Paula, Thiago C; Giusti, Karla G D; Domiciano, Rafael A M; Noya-Rabelo, Márcia M; Hamilton, Alan M; Loures, Vitor A; Dionísio, Rodrigo M; Furquim, Thyago A B; De Luca, Fábio A; Dos Santos Sousa, Ítalo B; Bandeira, Bruno S; Zukowski, Cleverson N; de Oliveira, Ricardo G G; Ribeiro, Noara B; de Moraes, Jeffer L; Petriz, João L F; Pimentel, Adriana M; Miranda, Jacqueline S; de Jesus Abufaiad, Bárbara E; Gibson, C Michael; Granger, Christopher B; Alexander, John H; de Souza, Olga F.
  • Lopes RD; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Macedo AVS; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
  • de Barros E Silva PGM; Brazilian Clinical Research Institute, São Paulo, Brazil.
  • Moll-Bernardes RJ; Rede D'Or São Luiz, São Paulo, Brazil.
  • Dos Santos TM; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Mazza L; Hospital São Luiz Jabaquara, São Paulo, Brazil.
  • Feldman A; Santa Casa de São Paulo, São Paulo, Brazil.
  • D'Andréa Saba Arruda G; Brazilian Clinical Research Institute, São Paulo, Brazil.
  • de Albuquerque DC; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Camiletti AS; Brazilian Clinical Research Institute, São Paulo, Brazil.
  • de Sousa AS; Insper Institute of Education and Research, São Paulo, Brazil.
  • de Paula TC; Brazilian Clinical Research Institute, São Paulo, Brazil.
  • Giusti KGD; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Domiciano RAM; Hospital São Luiz Anália Franco, São Paulo, Brazil.
  • Noya-Rabelo MM; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Hamilton AM; Hospital São Luiz São Caetano, São Caetano do Sul, Brazil.
  • Loures VA; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Dionísio RM; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
  • Furquim TAB; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • De Luca FA; Rede D'Or São Luiz, São Paulo, Brazil.
  • Dos Santos Sousa ÍB; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
  • Bandeira BS; Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
  • Zukowski CN; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
  • de Oliveira RGG; Hospital São Luiz Jabaquara, São Paulo, Brazil.
  • Ribeiro NB; Hospital Villa Lobos, São Paulo, Brazil.
  • de Moraes JL; Hospital São Luiz Anália Franco, São Paulo, Brazil.
  • Petriz JLF; Hospital São Rafael, Salvador, Brazil.
  • Pimentel AM; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
  • Miranda JS; Hospital São Rafael, Salvador, Brazil.
  • de Jesus Abufaiad BE; Hospital São Luiz Anália Franco, São Paulo, Brazil.
  • Gibson CM; Hospital SinoBrasileiro, Osasco, Brazil.
  • Granger CB; Hospital SinoBrasileiro, Osasco, Brazil.
  • Alexander JH; Hospital São Luiz Morumbi, São Paulo, Brazil.
  • de Souza OF; Hospital São Luiz Morumbi, São Paulo, Brazil.
JAMA ; 325(3): 254-264, 2021 01 19.
Article in English | MEDLINE | ID: covidwho-1239953
ABSTRACT
Importance It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Objective:

To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, Setting, and

Participants:

A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled April 9-June 26, 2020; final follow-up July 26, 2020).

Interventions:

Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main Outcomes and

Measures:

The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression.

Results:

Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and Relevance Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. Trial Registration ClinicalTrials.gov Identifier NCT04364893.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Angiotensin-Converting Enzyme Inhibitors / Withholding Treatment / Angiotensin Receptor Antagonists / SARS-CoV-2 / COVID-19 Drug Treatment Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2020.25864

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Angiotensin-Converting Enzyme Inhibitors / Withholding Treatment / Angiotensin Receptor Antagonists / SARS-CoV-2 / COVID-19 Drug Treatment Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2020.25864