REPLACE COVID Bolsters Advice to Continue RAAS Inhibitors in COVID-19 Patients from buzai232's blog

REPLACE COVID Bolsters Advice to Continue RAAS Inhibitors in COVID-19 Patients

Another randomized trial, REPLACE COVID, indicates that patients already taking ACE inhibitors and ARBs when they’re hospitalized for COVID-19 should continue to do so, supporting recommendations from international CV societies.To get more news about RaaS, you can visit glprobotics.com official website.

When it came to outcomes including all-cause death, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, and multiorgan dysfunction during hospitalization, there were no differences between patients who continued versus discontinued their renin-angiotensin-aldosterone-system (RAAS) inhibitors after they were admitted, researchers report in a study published online last week in the Lancet Respiratory Medicine.

Considering these findings and those from the BRACE CORONA trial, presented last year at the virtual European Society of Cardiology Congress, the message is simple, according to senior author Julio Chirinos, MD, PhD (University of Pennsylvania, Philadelphia). “In people who fall ill with COVID-19 requiring hospital admission, continuing these medications for established indications should be considered safe.”

Early after SARS-CoV-2 started circulating around the world, there were concerns that use of RAAS inhibitors might worsen the severity of COVID-19. That’s because there was some evidence that the agents increase the expression of ACE2, which has been shown to facilitate entry of the novel coronavirus into host cells.

International CV societies came out in favor of continuing ACE inhibitors and ARBs in patients hospitalized with COVID-19 while acknowledging the need for better data exploring the issue. Subsequent observational studies mostly suggested that there was no relationship between outpatient use of RAAS inhibitors and risk of COVID-19 hospitalizations or mortality, but randomized trials were launched to provide more-definitive insights.

REPLACE COVID, co-led by Chirinos and Jordana Cohen, MD (University of Pennsylvania), was a randomized, open-label trial conducted at 20 hospitals in the United States, Canada, Mexico, Sweden, Peru, Bolivia, and Argentina. It included 152 hypertensive patients (mean age 62 years; 45% women) randomized to continue or discontinue their ACE inhibitors and ARBs.

The primary outcome consisted of a global rank score that incorporated time to death; duration of mechanical ventilation or extracorporeal membrane oxygenation; time on renal replacement or inotropic or vasopressor therapy; and multiorgan dysfunction during hospitalization, assessed with the modified Sequential Organ Failure Assessment (SOFA) score. The global rank score did not significantly differ between the continuation and discontinuation arms (median 73 vs 81; P = 0.61).

There were also no differences in any of the secondary outcomes, including all-cause death (15% vs 13%; P = 0.99) and median length of the hospital stay (6 vs 5 days; P = 0.56).

Adverse events occurred in 39% of patients who continued their RAAS inhibitors and 36% of those who stopped taking them (P = 0.77). Blood pressure and serum levels of potassium and creatinine during follow-up were similar in the two trial arms.

“Our findings, derived from a prospective, multicenter, randomized, controlled design, are consistent with previously published observational studies and unpublished trial evidence, which have generally shown no difference in the risk of SARS-CoV-2 infection and COVID-19 severity among patients who are treated with ACE inhibitors or ARBs compared with those who are not,” the authors conclude.