A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19 - 05/04/22
, Malik Elharram, MD, MSc a, b, Jonathan Afilalo, MD, MSc c, Alexandria Flannery, RN b, Marc Afilalo, MD d, Chris Tselios, MD d, Jiayi Ni, MSc a, b, Justin A. Ezekowitz, MBBCh, MSc e, Matthew P. Cheng, MDCM f, Andrew P. Ambrosy, MD g, h, Faiez Zannad, MD, PhD i, James M. Brophy, MD, PhD a, Nadia Giannetti, MD a, Amal Bessissow, MD, MSc j, Nadine Kronfli, MD, MPH f, Ariane Marelli, MD, MPH a, Haya Aziz, MDCM a, Mohammad Alqahtani, MD j, Mona Aflaki, MD, PhD j, Morgan Craig, PhD k, Renato D. Lopes, MD, PhD l, João Pedro Ferreira, MD, PhD i, m
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Résumé |
Background |
Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes.
Methods |
The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-to-treat principle.
Results |
Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients’ mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); P = .60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06-2.62]; P = .027); RAASi discontinuation increased brain natriuretic peptide levels (% change from baseline: +16.7% vs -27.5%; P = .024) and the incidence of acute heart failure (33% vs 4.2%, P = .016).
Conclusion |
RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased brain natriuretic peptide levels and may increase risk of acute heart failure; where possible, RAASi should be continued.
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Vol 247
P. 76-89 - mai 2022 Retour au numéro
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