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.