Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial
The REPLACE COVID trial (n=152) found continuation of RAS inhibitors had no effect on global rank score (time to death, duration of mechanical ventilation, time on renal replacement/vasopressor therapy, multi-organ dysfunction); the authors recommend they can be safely continued.
Source:
The Lancet Respiratory Medicine
Resource links:
SPS commentary:
An associated comment discusses the previous observational research demonstrating chronic treatment with ACEIs or ARBs was not associated with increased risk of becoming infected with SARS-CoV-2, or of becoming hospitalised or dying from COVID-19. The current report represents the first results from an RCT, which used a hierarchical global rank score to compensate for its small size, and to increase power for the primary outcome.
Although this study alone would not provide sufficient reassurance and it does not address the question of whether chronic treatment with RAS inhibitors increases susceptibility to infection, it provides a consistent message when combined with the previous large observational studies. Its results are also consistent with those from a similar but as-yet unpublished study conducted in Brazil (BRACE CORONA). Of note however the mean age of the study population was lower than what would be typically seen in the most severely ill Covid-19 patients, and it excluded those with heart failure (due to higher perceived risk of withdrawing RAS inhibitor therapy).