Thread by @leticiakawano

1/ Awesome 🤩: RCTs coming out answering important questions on Covid19!

A trial designed/coordinated by 🇧🇷 trialists @RenatoDLopes1 @damiani_petri Pedro Barros

DSMB chaired by Alexandre Biasi, who I luckily can call a friend

thread:

jamanetwork.com/journals/jama/… @JAMA_current

2/ Why this trial was needed? 🧐

ACE2 is the receptor for SARS-CoV-2

Select preclinical investigations have shown upregulation of ACE2 by RAAS inhibitors (such as ACEIs and ARBs), raising concerns about their safety in patients with COVID-19

science.sciencemag.org/content/367/64…

3/ A multicenter open-label RCT with blinded end-point assessment was performed:

POPULATION: 659 pts hospitalized with COVID-19 who were taking ACEIs or ARBs prior to hospital admission (mild and moderate Covid19)

INTERVENTION: discontinuation vs continuation RAAS inhibitors

4/
PS: For patients randomized to the discontinuation group, other drugs could replace the RAAS inhibitors at the discretion of the treating physician.
β-Blockers for HF were maintained

OUTCOME: Days Alive and Out of the Hospital

5/
1ary outcome effect consistent across major predefined subgroups (age, obesity, ACEI vs ARB)

BUT, there was a significant interaction with the results slightly favoring the group continuing ACEI or ARB therapy among patients with lower SpO2 and ⬆️baseline disease severity

6/ Some important baseline characteristics of the trial pop (in order for you to access external validity):

All pts Sp02 < 94% in room air
Mean age ~55 (around 15% older than 70)
BMI ~30
100% Hypertension
VERY small proportion of HF or CKD

7/ Important message: it is REASSURING to keep patients on ACEi/ARB when admitted to the hospital due to Covid19

Congrats to everyone involved!
FYI: between trial design and result presentation at the late break Cardiology European Congress = 5 months 😱 #CovidTimes