Discontinuing vs continuing ACEIs and ARBs in hospitalized patients with COVID-19 according to disease severity: Insights from the BRACE CORONA trial - 23/05/22

Doi : 10.1016/j.ahj.2022.04.001

Ariane Vieira Scarlatelli Macedo, MD, MSc ^a,^b,^c,^d, Pedro Gabriel Melo de Barros e Silva, MD, PhD ^d,^e, Thiago Ceccatto de Paula, MD ^b,^d, Renata Junqueira Moll-Bernardes, MD, PhD ^a, Tiago Mendonça dos Santos, MSc ^d,^f, Lilian Mazza, RT ^d, Andre Feldman, MD, PhD ^a,^g, Guilherme D`Andréa Saba Arruda, MD ^a,^h, Denílson Campos de Albuquerque, MD, PhD ^a,ⁱ, Andrea Silvestre de Sousa, MD, PhD ^a,^j,^k, Olga Ferreira de Souza, MD, PhD ^a,^l,^m, C. Michael Gibson, MD ⁿ, Christopher B. Granger, MD ^o, John H. Alexander, MD, MHS ^o, Renato D. Lopes, MD, PhD ^a,^c,^d,^l,^o,^⁎
^a D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
^b Hospital São Luiz Jabaquara, São Paulo, Brazil
^c Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo, São Paulo, Brazil
^d Brazilian Clinical Research Institute, São Paulo, Brazil
^e Centro Universitário São Camilo, São Paulo, Brazil
^f Insper Institute of Education and Research, São Paulo, Brazil
^g Hospital São Luiz Anália Franco, São Paulo, Brazil
^h Hospital São Luiz São Caetano, São Caetano do Sul, Brazil
ⁱ Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
^j Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
^k Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
^l Rede D'Or São Luiz (RDSL), São Paulo, Brazil
^m Hospital Copa D'Or, Rio de Janeiro, Brazil
ⁿ Harvard Medical School, Boston, MA, USA
^o Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA

^⁎Reprint requests: Renato D. Lopes, MD, PhD, Duke Clinical Research Institute, 300 W Morgan Street, Durham, NC 27701.Duke Clinical Research Institute300 W Morgan StreetDurhamNC27701

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Riassunto

Background

We explored the effect of discontinuing versus continuing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on clinical outcomes in patients with COVID-19 according to baseline disease severity.

Methods

We randomized 659 patients with a confirmed diagnosis of COVID-19 and classified them as having mild or moderate COVID-19 disease severity at hospital presentation using blood oxygen saturation and lung imaging. The primary outcome was the mean ratio of number of days alive and out of the hospital at 30 days according to disease severity.

Results

At presentation, 376 patients (57.1%) had mild and 283 (42.9%) had moderate COVID-19. In patients with mild disease, there was no significant difference in the number of days alive and out of the hospital between ACEI/ARB discontinuation (mean 23.5 [SD 6.3] days) and continuation (mean 23.8 [SD 6.5] days), with a mean ratio of 0.98 (95% CI 0.92-1.04). However, in patients with moderate disease, there were fewer days alive and out of the hospital with ACEI/ARB discontinuation (mean 19.6 [SD 9.5] days) than continuation (mean 21.6 [SD 7.6] days), with a mean ratio of 0.90 (95% CI 0.81-1.00; P-interaction = .01). The impact of discontinuing versus continuing ACEIs/ARBs on days alive and out of hospital through 30 days differed according to baseline COVID-19 disease severity.

Conclusions

Unlike patients with mild disease, patients with moderate disease who continued ACEIs/ARBs had more days alive and out of hospital through 30 days than those who discontinued ACEIs/ARBs. This suggests that ACEIs/ARBs should be continued for patients with moderate COVID-19 disease severity.

Clinical Trial Registration

ClinicalTrials.gov (NCT04364893).

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Baseline Characteristics

Laboratory Results at Baseline

Concomitant Medications

Disease progression

Treatment effect according to clinical severity at presentation

Primary outcome according to disease progression

Secondary outcomes according to disease severity at presentation

Esportazione

Vol 249

P. 86-97 - Luglio 2022 Ritorno al numero

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Discontinuing vs continuing ACEIs and ARBs in hospitalized patients with COVID-19 according to disease severity: Insights from the BRACE CORONA trial - 23/05/22

Riassunto

Background

Methods

Results

Conclusions

Clinical Trial Registration

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