Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial.
Aged
Angiotensin Receptor Antagonists
/ therapeutic use
Angiotensin-Converting Enzyme Inhibitors
/ therapeutic use
COVID-19
/ complications
Cardiovascular Diseases
/ drug therapy
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Prospective Studies
Respiration, Artificial
/ statistics & numerical data
SARS-CoV-2
Treatment Outcome
Withholding Treatment
/ statistics & numerical data
Journal
The Lancet. Respiratory medicine
ISSN: 2213-2619
Titre abrégé: Lancet Respir Med
Pays: England
ID NLM: 101605555
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
18
10
2020
revised:
25
11
2020
accepted:
25
11
2020
pubmed:
11
1
2021
medline:
20
3
2021
entrez:
10
1
2021
Statut:
ppublish
Résumé
Biological considerations suggest that renin-angiotensin system inhibitors might influence the severity of COVID-19. We aimed to evaluate whether continuing versus discontinuing renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) affects outcomes in patients admitted to hospital with COVID-19. The REPLACE COVID trial was a prospective, randomised, open-label trial done at 20 large referral hospitals in seven countries worldwide. Eligible participants were aged 18 years and older who were admitted to hospital with COVID-19 and were receiving a renin-angiotensin system inhibitor before admission. Individuals with contraindications to continuation or discontinuation of renin-angiotensin system inhibitor therapy were excluded. Participants were randomly assigned (1:1) to continuation or discontinuation of their renin-angiotensin system inhibitor using permuted block randomisation, with allocation concealed using a secure web-based randomisation system. The primary outcome was a global rank score in which participants were ranked across four hierarchical tiers incorporating time to death, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, and multiorgan dysfunction during the hospitalisation. Primary analyses were done in the intention-to-treat population. The REPLACE COVID trial is registered with ClinicalTrials.gov, NCT04338009. Between March 31 and Aug 20, 2020, 152 participants were enrolled and randomly assigned to either continue or discontinue renin-angiotensin system inhibitor therapy (continuation group n=75; discontinuation group n=77). Mean age of participants was 62 years (SD 12), 68 (45%) were female, mean body-mass index was 33 kg/m Consistent with international society recommendations, renin-angiotensin system inhibitors can be safely continued in patients admitted to hospital with COVID-19. REPLACE COVID Investigators, REPLACE COVID Trial Social Fundraising Campaign, and FastGrants.
Sections du résumé
BACKGROUND
Biological considerations suggest that renin-angiotensin system inhibitors might influence the severity of COVID-19. We aimed to evaluate whether continuing versus discontinuing renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) affects outcomes in patients admitted to hospital with COVID-19.
METHODS
The REPLACE COVID trial was a prospective, randomised, open-label trial done at 20 large referral hospitals in seven countries worldwide. Eligible participants were aged 18 years and older who were admitted to hospital with COVID-19 and were receiving a renin-angiotensin system inhibitor before admission. Individuals with contraindications to continuation or discontinuation of renin-angiotensin system inhibitor therapy were excluded. Participants were randomly assigned (1:1) to continuation or discontinuation of their renin-angiotensin system inhibitor using permuted block randomisation, with allocation concealed using a secure web-based randomisation system. The primary outcome was a global rank score in which participants were ranked across four hierarchical tiers incorporating time to death, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, and multiorgan dysfunction during the hospitalisation. Primary analyses were done in the intention-to-treat population. The REPLACE COVID trial is registered with ClinicalTrials.gov, NCT04338009.
FINDINGS
Between March 31 and Aug 20, 2020, 152 participants were enrolled and randomly assigned to either continue or discontinue renin-angiotensin system inhibitor therapy (continuation group n=75; discontinuation group n=77). Mean age of participants was 62 years (SD 12), 68 (45%) were female, mean body-mass index was 33 kg/m
INTERPRETATION
Consistent with international society recommendations, renin-angiotensin system inhibitors can be safely continued in patients admitted to hospital with COVID-19.
FUNDING
REPLACE COVID Investigators, REPLACE COVID Trial Social Fundraising Campaign, and FastGrants.
Identifiants
pubmed: 33422263
pii: S2213-2600(20)30558-0
doi: 10.1016/S2213-2600(20)30558-0
pmc: PMC7832152
pii:
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Banques de données
ClinicalTrials.gov
['NCT04338009']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
275-284Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL133843
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK092926
Pays : United States
Organisme : NHLBI NIH HHS
ID : R03 HL146874
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL104106
Pays : United States
Organisme : NHLBI NIH HHS
ID : R61 HL146390
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL121510
Pays : United States
Organisme : NHLBI NIH HHS
ID : R56 HL136730
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG058969
Pays : United States
Organisme : NHLBI NIH HHS
ID : P01 HL094307
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007785
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007891
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL153646
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
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