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An open-label, prospective, randomized trial (REPLACE COVID) was performed to determine if continuing versus discontinuing renin-angiotensin system inhibitors impact outcomes in coronavirus-infected 152 subjects.
Renin-angiotensin system inhibitors (angiotensin-converting
enzyme inhibitors or angiotensin receptor blockers) can be continued safely in
individuals hospitalized with coronavirus disease (COVID)-19 unless there is a definite medical
contraindication to the ongoing treatment.
An open-label, prospective, randomized trial (REPLACE COVID)
was performed to determine if continuing versus discontinuing renin-angiotensin
system inhibitors impact outcomes in coronavirus-infected 152 subjects.
Individuals (age 18 years and older) were hospitalized with
COVID-19 and were being given a renin-angiotensin system inhibitor therapy
prior to hospitalization. Subjects with contraindications to continuing or
discontinuing of renin-angiotensin system inhibitor treatment were not
included.
Utilizing a permuted block randomization, subjects were randomized to continuation or discontinuation of their renin-angiotensin system inhibitor (Group A: Continuation arm [n=75]; Group B: Discontinuation arm [n=77]). Utilizing a secure web-based randomization system, the allocation was concealed.
The major endpoint was a global rank score in which the
subjects were ranked across four hierarchical tiers including the duration of
mechanical ventilation, time to mortality, time on renal replacement or
vasopressor treatment, and multiorgan dysfunction during hospitalization. In
intention-to-treat population, primary assessment was carried out.
Compared to Group B, Group A was found to have no effect on the global rank score. Both the groups displayed comparable outcomes. The percentage of individuals: (i) requiring intensive care unit admission or invasive mechanical ventilation, (ii) died (iii) having at least one adverse event is shown in the below table:
During follow-up, no difference in serum potassium,
creatinine, or blood pressure was noted between the cohorts.
Continuation in comparison with discontinuation of
renin-angiotensin system inhibitor treatment does not considerably impact the
severity or duration of hospitalization.
The Lancet Respiratory Medicine
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial
Jordana B Cohen et al.
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