Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial
- Autores
- Cohen, Jordana B.; Hanff, Thomas C.; William, Preethi; Sweitzer, Nancy; Rosado Santander, Nelson R.; Medina, Carola; Rodriguez-Mori, Juan E; Renna, Nicolas Federico; Chang, Tara I.; Corrales Medina, Vicente; Andrade Villanueva, Jaime F.; Barbagelata, Alejandro; Cristodulo Cortez, Roberto; Díaz-Cucho, Omar A; Spaak, Jonas; Alfonso, Carlos E.; Valdivia Vega, Renzo; Villavicencio Carranza, Mirko; Ayala García, Ricardo J.; Castro Callirgos, Carlos A.; González Hernández, Luz A.; Bernales Salas, Eduardo F.; Coacalla Guerra, Johanna C.; Salinas Herrera, Cynthia D.; Nicolosi, Liliana; Basconcel, Mauro; Byrd, James B.; Sharkoski, Tiffany; Bendezú Huasasquiche, Luis E.; Chittams, Jesse; Edmonston, Daniel L.; Vasquez, Charles R.; Chirinos, Julio A.
- Año de publicación
- 2021
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- 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/m2 (SD 8), and 79 (52%) had diabetes. Compared with discontinuation of renin–angiotensin system inhibitors, continuation had no effect on the global rank score (median rank 73 [IQR 40–110] for continuation vs 81 [38–117] for discontinuation; β-coefficient 8 [95% CI −13 to 29]). There were 16 (21%) of 75 participants in the continuation arm versus 14 (18%) of 77 in the discontinuation arm who required intensive care unit admission or invasive mechanical ventilation, and 11 (15%) of 75 participants in the continuation group versus ten (13%) of 77 in the discontinuation group died. 29 (39%) participants in the continuation group and 28 (36%) participants in the discontinuation group had at least one adverse event (χ2 test of adverse events between treatment groups p=0·77). There was no difference in blood pressure, serum potassium, or creatinine during follow-up across the two groups. 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.
Fil: Cohen, Jordana B.. State University of Pennsylvania; Estados Unidos
Fil: Hanff, Thomas C.. State University of Pennsylvania; Estados Unidos
Fil: William, Preethi. University of Arizona; Estados Unidos
Fil: Sweitzer, Nancy. University of Arizona; Estados Unidos
Fil: Rosado Santander, Nelson R.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú
Fil: Medina, Carola. Hospital Nacional Edgardo Rebagliati Martins; Perú
Fil: Rodriguez-Mori, Juan E. Hospital Nacional Alberto Sabogal Sologuren; Perú
Fil: Renna, Nicolas Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo; Argentina
Fil: Chang, Tara I.. University of Stanford; Estados Unidos
Fil: Corrales Medina, Vicente. Ottawa Hospital Research Institute; Canadá
Fil: Andrade Villanueva, Jaime F.. Hospital Civil de Guadalajara; México
Fil: Barbagelata, Alejandro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. University of Duke; Estados Unidos
Fil: Cristodulo Cortez, Roberto. No especifíca;
Fil: Díaz-Cucho, Omar A. Hospital Alberto Leopoldo Barton Thompson; Perú
Fil: Spaak, Jonas. Danderyd University Hospital; Suecia
Fil: Alfonso, Carlos E.. University of Miami; Estados Unidos
Fil: Valdivia Vega, Renzo. Hospital Nacional Edgardo Rebagliati Martins; Perú
Fil: Villavicencio Carranza, Mirko. Hospital Nacional Edgardo Rebagliati Martins; Perú
Fil: Ayala García, Ricardo J.. Hospital Nacional Edgardo Rebagliati Martins; Perú
Fil: Castro Callirgos, Carlos A.. Hospital Nacional Edgardo Rebagliati Martins; Perú
Fil: González Hernández, Luz A.. Hospital Civil de Guadalajara; México
Fil: Bernales Salas, Eduardo F.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú
Fil: Coacalla Guerra, Johanna C.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú
Fil: Salinas Herrera, Cynthia D.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú
Fil: Nicolosi, Liliana. Hospital Espanol; Argentina
Fil: Basconcel, Mauro. Hospital Espanol; Argentina
Fil: Byrd, James B.. University of Michigan; Estados Unidos
Fil: Sharkoski, Tiffany. University of Pennsylvania; Estados Unidos
Fil: Bendezú Huasasquiche, Luis E.. Hospital Alberto Leopoldo Barton Thompson; Perú
Fil: Chittams, Jesse. University of Pennsylvania; Estados Unidos
Fil: Edmonston, Daniel L.. University of Duke; Estados Unidos
Fil: Vasquez, Charles R.. University of Pennsylvania; Estados Unidos
Fil: Chirinos, Julio A.. University of Pennsylvania; Estados Unidos - Materia
-
COVID-19
SRAA
Hipertension Arterial - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
- Repositorio
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/135156
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Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trialCohen, Jordana B.Hanff, Thomas C.William, PreethiSweitzer, NancyRosado Santander, Nelson R.Medina, CarolaRodriguez-Mori, Juan ERenna, Nicolas FedericoChang, Tara I.Corrales Medina, VicenteAndrade Villanueva, Jaime F.Barbagelata, AlejandroCristodulo Cortez, RobertoDíaz-Cucho, Omar ASpaak, JonasAlfonso, Carlos E.Valdivia Vega, RenzoVillavicencio Carranza, MirkoAyala García, Ricardo J.Castro Callirgos, Carlos A.González Hernández, Luz A.Bernales Salas, Eduardo F.Coacalla Guerra, Johanna C.Salinas Herrera, Cynthia D.Nicolosi, LilianaBasconcel, MauroByrd, James B.Sharkoski, TiffanyBendezú Huasasquiche, Luis E.Chittams, JesseEdmonston, Daniel L.Vasquez, Charles R.Chirinos, Julio A.COVID-19SRAAHipertension Arterialhttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Background: 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/m2 (SD 8), and 79 (52%) had diabetes. Compared with discontinuation of renin–angiotensin system inhibitors, continuation had no effect on the global rank score (median rank 73 [IQR 40–110] for continuation vs 81 [38–117] for discontinuation; β-coefficient 8 [95% CI −13 to 29]). There were 16 (21%) of 75 participants in the continuation arm versus 14 (18%) of 77 in the discontinuation arm who required intensive care unit admission or invasive mechanical ventilation, and 11 (15%) of 75 participants in the continuation group versus ten (13%) of 77 in the discontinuation group died. 29 (39%) participants in the continuation group and 28 (36%) participants in the discontinuation group had at least one adverse event (χ2 test of adverse events between treatment groups p=0·77). There was no difference in blood pressure, serum potassium, or creatinine during follow-up across the two groups. 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.Fil: Cohen, Jordana B.. State University of Pennsylvania; Estados UnidosFil: Hanff, Thomas C.. State University of Pennsylvania; Estados UnidosFil: William, Preethi. University of Arizona; Estados UnidosFil: Sweitzer, Nancy. University of Arizona; Estados UnidosFil: Rosado Santander, Nelson R.. Hospital Nacional Carlos Alberto Seguin Escobedo; PerúFil: Medina, Carola. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Rodriguez-Mori, Juan E. Hospital Nacional Alberto Sabogal Sologuren; PerúFil: Renna, Nicolas Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo; ArgentinaFil: Chang, Tara I.. University of Stanford; Estados UnidosFil: Corrales Medina, Vicente. Ottawa Hospital Research Institute; CanadáFil: Andrade Villanueva, Jaime F.. Hospital Civil de Guadalajara; MéxicoFil: Barbagelata, Alejandro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. University of Duke; Estados UnidosFil: Cristodulo Cortez, Roberto. No especifíca;Fil: Díaz-Cucho, Omar A. Hospital Alberto Leopoldo Barton Thompson; PerúFil: Spaak, Jonas. Danderyd University Hospital; SueciaFil: Alfonso, Carlos E.. University of Miami; Estados UnidosFil: Valdivia Vega, Renzo. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Villavicencio Carranza, Mirko. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Ayala García, Ricardo J.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Castro Callirgos, Carlos A.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Hernández, Luz A.. Hospital Civil de Guadalajara; MéxicoFil: Bernales Salas, Eduardo F.. Hospital Nacional Carlos Alberto Seguin Escobedo; PerúFil: Coacalla Guerra, Johanna C.. Hospital Nacional Carlos Alberto Seguin Escobedo; PerúFil: Salinas Herrera, Cynthia D.. Hospital Nacional Carlos Alberto Seguin Escobedo; PerúFil: Nicolosi, Liliana. Hospital Espanol; ArgentinaFil: Basconcel, Mauro. Hospital Espanol; ArgentinaFil: Byrd, James B.. University of Michigan; Estados UnidosFil: Sharkoski, Tiffany. University of Pennsylvania; Estados UnidosFil: Bendezú Huasasquiche, Luis E.. Hospital Alberto Leopoldo Barton Thompson; PerúFil: Chittams, Jesse. University of Pennsylvania; Estados UnidosFil: Edmonston, Daniel L.. University of Duke; Estados UnidosFil: Vasquez, Charles R.. University of Pennsylvania; Estados UnidosFil: Chirinos, Julio A.. University of Pennsylvania; Estados UnidosElsevier2021-03info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/135156Cohen, Jordana B.; Hanff, Thomas C.; William, Preethi; Sweitzer, Nancy; Rosado Santander, Nelson R.; et al.; Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial; Elsevier; The Lancet Respiratory Medicine; 9; 3; 3-2021; 275-2842213-26002213-2619CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1016/S2213-2600(20)30558-0info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T09:54:07Zoai:ri.conicet.gov.ar:11336/135156instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 09:54:08.113CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
dc.title.none.fl_str_mv |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
title |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
spellingShingle |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial Cohen, Jordana B. COVID-19 SRAA Hipertension Arterial |
title_short |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
title_full |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
title_fullStr |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
title_full_unstemmed |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
title_sort |
Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial |
dc.creator.none.fl_str_mv |
Cohen, Jordana B. Hanff, Thomas C. William, Preethi Sweitzer, Nancy Rosado Santander, Nelson R. Medina, Carola Rodriguez-Mori, Juan E Renna, Nicolas Federico Chang, Tara I. Corrales Medina, Vicente Andrade Villanueva, Jaime F. Barbagelata, Alejandro Cristodulo Cortez, Roberto Díaz-Cucho, Omar A Spaak, Jonas Alfonso, Carlos E. Valdivia Vega, Renzo Villavicencio Carranza, Mirko Ayala García, Ricardo J. Castro Callirgos, Carlos A. González Hernández, Luz A. Bernales Salas, Eduardo F. Coacalla Guerra, Johanna C. Salinas Herrera, Cynthia D. Nicolosi, Liliana Basconcel, Mauro Byrd, James B. Sharkoski, Tiffany Bendezú Huasasquiche, Luis E. Chittams, Jesse Edmonston, Daniel L. Vasquez, Charles R. Chirinos, Julio A. |
author |
Cohen, Jordana B. |
author_facet |
Cohen, Jordana B. Hanff, Thomas C. William, Preethi Sweitzer, Nancy Rosado Santander, Nelson R. Medina, Carola Rodriguez-Mori, Juan E Renna, Nicolas Federico Chang, Tara I. Corrales Medina, Vicente Andrade Villanueva, Jaime F. Barbagelata, Alejandro Cristodulo Cortez, Roberto Díaz-Cucho, Omar A Spaak, Jonas Alfonso, Carlos E. Valdivia Vega, Renzo Villavicencio Carranza, Mirko Ayala García, Ricardo J. Castro Callirgos, Carlos A. González Hernández, Luz A. Bernales Salas, Eduardo F. Coacalla Guerra, Johanna C. Salinas Herrera, Cynthia D. Nicolosi, Liliana Basconcel, Mauro Byrd, James B. Sharkoski, Tiffany Bendezú Huasasquiche, Luis E. Chittams, Jesse Edmonston, Daniel L. Vasquez, Charles R. Chirinos, Julio A. |
author_role |
author |
author2 |
Hanff, Thomas C. William, Preethi Sweitzer, Nancy Rosado Santander, Nelson R. Medina, Carola Rodriguez-Mori, Juan E Renna, Nicolas Federico Chang, Tara I. Corrales Medina, Vicente Andrade Villanueva, Jaime F. Barbagelata, Alejandro Cristodulo Cortez, Roberto Díaz-Cucho, Omar A Spaak, Jonas Alfonso, Carlos E. Valdivia Vega, Renzo Villavicencio Carranza, Mirko Ayala García, Ricardo J. Castro Callirgos, Carlos A. González Hernández, Luz A. Bernales Salas, Eduardo F. Coacalla Guerra, Johanna C. Salinas Herrera, Cynthia D. Nicolosi, Liliana Basconcel, Mauro Byrd, James B. Sharkoski, Tiffany Bendezú Huasasquiche, Luis E. Chittams, Jesse Edmonston, Daniel L. Vasquez, Charles R. Chirinos, Julio A. |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.subject.none.fl_str_mv |
COVID-19 SRAA Hipertension Arterial |
topic |
COVID-19 SRAA Hipertension Arterial |
purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.2 https://purl.org/becyt/ford/3 |
dc.description.none.fl_txt_mv |
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/m2 (SD 8), and 79 (52%) had diabetes. Compared with discontinuation of renin–angiotensin system inhibitors, continuation had no effect on the global rank score (median rank 73 [IQR 40–110] for continuation vs 81 [38–117] for discontinuation; β-coefficient 8 [95% CI −13 to 29]). There were 16 (21%) of 75 participants in the continuation arm versus 14 (18%) of 77 in the discontinuation arm who required intensive care unit admission or invasive mechanical ventilation, and 11 (15%) of 75 participants in the continuation group versus ten (13%) of 77 in the discontinuation group died. 29 (39%) participants in the continuation group and 28 (36%) participants in the discontinuation group had at least one adverse event (χ2 test of adverse events between treatment groups p=0·77). There was no difference in blood pressure, serum potassium, or creatinine during follow-up across the two groups. 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. Fil: Cohen, Jordana B.. State University of Pennsylvania; Estados Unidos Fil: Hanff, Thomas C.. State University of Pennsylvania; Estados Unidos Fil: William, Preethi. University of Arizona; Estados Unidos Fil: Sweitzer, Nancy. University of Arizona; Estados Unidos Fil: Rosado Santander, Nelson R.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú Fil: Medina, Carola. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Rodriguez-Mori, Juan E. Hospital Nacional Alberto Sabogal Sologuren; Perú Fil: Renna, Nicolas Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo; Argentina Fil: Chang, Tara I.. University of Stanford; Estados Unidos Fil: Corrales Medina, Vicente. Ottawa Hospital Research Institute; Canadá Fil: Andrade Villanueva, Jaime F.. Hospital Civil de Guadalajara; México Fil: Barbagelata, Alejandro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. University of Duke; Estados Unidos Fil: Cristodulo Cortez, Roberto. No especifíca; Fil: Díaz-Cucho, Omar A. Hospital Alberto Leopoldo Barton Thompson; Perú Fil: Spaak, Jonas. Danderyd University Hospital; Suecia Fil: Alfonso, Carlos E.. University of Miami; Estados Unidos Fil: Valdivia Vega, Renzo. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Villavicencio Carranza, Mirko. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Ayala García, Ricardo J.. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Castro Callirgos, Carlos A.. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: González Hernández, Luz A.. Hospital Civil de Guadalajara; México Fil: Bernales Salas, Eduardo F.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú Fil: Coacalla Guerra, Johanna C.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú Fil: Salinas Herrera, Cynthia D.. Hospital Nacional Carlos Alberto Seguin Escobedo; Perú Fil: Nicolosi, Liliana. Hospital Espanol; Argentina Fil: Basconcel, Mauro. Hospital Espanol; Argentina Fil: Byrd, James B.. University of Michigan; Estados Unidos Fil: Sharkoski, Tiffany. University of Pennsylvania; Estados Unidos Fil: Bendezú Huasasquiche, Luis E.. Hospital Alberto Leopoldo Barton Thompson; Perú Fil: Chittams, Jesse. University of Pennsylvania; Estados Unidos Fil: Edmonston, Daniel L.. University of Duke; Estados Unidos Fil: Vasquez, Charles R.. University of Pennsylvania; Estados Unidos Fil: Chirinos, Julio A.. University of Pennsylvania; Estados Unidos |
description |
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/m2 (SD 8), and 79 (52%) had diabetes. Compared with discontinuation of renin–angiotensin system inhibitors, continuation had no effect on the global rank score (median rank 73 [IQR 40–110] for continuation vs 81 [38–117] for discontinuation; β-coefficient 8 [95% CI −13 to 29]). There were 16 (21%) of 75 participants in the continuation arm versus 14 (18%) of 77 in the discontinuation arm who required intensive care unit admission or invasive mechanical ventilation, and 11 (15%) of 75 participants in the continuation group versus ten (13%) of 77 in the discontinuation group died. 29 (39%) participants in the continuation group and 28 (36%) participants in the discontinuation group had at least one adverse event (χ2 test of adverse events between treatment groups p=0·77). There was no difference in blood pressure, serum potassium, or creatinine during follow-up across the two groups. 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. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-03 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo |
format |
article |
status_str |
publishedVersion |
dc.identifier.none.fl_str_mv |
http://hdl.handle.net/11336/135156 Cohen, Jordana B.; Hanff, Thomas C.; William, Preethi; Sweitzer, Nancy; Rosado Santander, Nelson R.; et al.; Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial; Elsevier; The Lancet Respiratory Medicine; 9; 3; 3-2021; 275-284 2213-2600 2213-2619 CONICET Digital CONICET |
url |
http://hdl.handle.net/11336/135156 |
identifier_str_mv |
Cohen, Jordana B.; Hanff, Thomas C.; William, Preethi; Sweitzer, Nancy; Rosado Santander, Nelson R.; et al.; Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial; Elsevier; The Lancet Respiratory Medicine; 9; 3; 3-2021; 275-284 2213-2600 2213-2619 CONICET Digital CONICET |
dc.language.none.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
info:eu-repo/semantics/altIdentifier/doi/10.1016/S2213-2600(20)30558-0 |
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info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by-nc-sa/2.5/ar/ |
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openAccess |
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https://creativecommons.org/licenses/by-nc-sa/2.5/ar/ |
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application/pdf application/pdf |
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Elsevier |
publisher.none.fl_str_mv |
Elsevier |
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Consejo Nacional de Investigaciones Científicas y Técnicas |
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CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.mail.fl_str_mv |
dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
_version_ |
1844613646179631104 |
score |
13.070432 |