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
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/135156

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oai_identifier_str oai:ri.conicet.gov.ar:11336/135156
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling 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
dc.type.none.fl_str_mv 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
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv 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