Drug trial found drugs neither beneficial nor harmful in treating inpatients – ScienceDaily

As part of the REPLACE COVID trial, researchers looked at whether ACE inhibitors (ACEIs) or angiotensin receptor inhibitors (ARBs) – two classes of drugs to treat high blood pressure – could help alleviate complications or cause more serious symptoms. More than 49 million American adults take medications to treat high blood pressure, and of these, about 83% (41 million) take an ACEI or ARA, according to the Centers for Disease Control and Prevention.

At the onset of the pandemic, concern arose over the use of ACEIs or ARBs in COVID-19, as some studies had suggested that these drugs could upregulate cell receptors for the SARS-CoV virus. -2, which could contribute to viral replication. However, it was also considered that some effects of these drugs could be protective against the virus.

“Observational studies were quickly carried out, but randomized trials are important in establishing a definitive answer regarding the potential impact of these high blood pressure drugs commonly used in COVID-19,” said Julio A. Chirinos , MD, study correspondent, PhD, associate professor of cardiovascular medicine at Perelman School of Medicine. “The results of our trial show in an important way that these drugs can be continued safely for patients hospitalized with COVID-19.”

ACEIs and ARBs are among the most commonly prescribed drugs in the world, and a potential link between these drugs and COVID-19 results has big implications for global health, say the authors. Several observational studies have suggested no association between outpatient use of CIRA or ARB and the risk of hospitalization with COVID-19, but evidence from high-quality randomized trials has so far been lacking.

For the trial, investigators recruited 152 participants in multiple countries between March 31 and August 20, 2020, who were hospitalized with COVID-19 and already using one of the drugs. Participants were randomly assigned to stop or continue taking their prescribed medication and closely monitored to assess the effect of temporarily stopping treatment.

Researchers have developed an innovative global ranking score to rank patient outcomes based on four factors: time to death, duration supported by mechanical ventilation or extracorporeal membrane oxygenation (ECMO), duration of treatment renal replacement therapy and a modified sequential assessment of organ failure. Goal. Analyzing patient outcome data, the team found that stopping ACEIs and ARBs versus continuing these drugs had no effect on the overall grading score.

This evidence supports the international society’s recommendations for continued treatment with ACEI and ARA in patients admitted to hospital with COVID-19, unless there is a clear and alternative medical issue with the current treatment. Classes.

“At the start of the pandemic, patients worried about perceived harm based on limited and incomplete information, and unfortunately some insisted on stopping their medications. However, stopping these medicines unnecessarily can increase the risk of serious complications, including heart attacks and strokes. Said first author Jordana B. Cohen, MD, MSCE, assistant professor in the division of renal electrolytes and hypertension and co-principal investigator with Chirinos. “We now have high quality evidence to support our recommendation that patients continue to take these drugs as prescribed.

Currently, trials are underway to determine whether the use of these drugs is effective for the treatment of COVID-19.

The trial was sponsored by investigators from the various registration centers; REPLACE COVID Trial Social Fundraising Campaign Supported Part of Penn Medicine Enrollment; FastGrants supported enrollment at the University of Michigan.