Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2021 |
| Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng |
| Título da fonte: | Repositório Institucional da FIOCRUZ (ARCA) |
| Texto Completo: | https://www.arca.fiocruz.br/handle/icict/46277 |
Resumo: | D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Duke University Medical Center. Duke Clinical Research Institute. Durham, North Carolina, USA / Brazilian Clinical Research Institute. São Paulo, SP, Brazil / Rede D'Or São Luiz. São Paulo, SP, Brazil. |
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Lopes, Renato D.Macedo, Ariane V. S.Barros-E-Silva, Pedro G. M. deMoll-Bernardes, Renata J.Santos, Tiago M. dosMazza, LilianFeldman, AndréArruda, Guilherme D'Andréa SabaAlbuquerque, Denílson C. deCamiletti, Angelina S.Sousa, Andréa S. dePaula, Thiago C. deGiusti, Karla G. D.Domiciano, Rafael A. M.Noya-Rabelo, Márcia M.Hamilton, Alan M.Loures, Vitor A.Dionísio, Rodrigo M.Furquim, Thyago A. B.De Luca, Fábio A.Sousa, Ítalo B. dos SantosBandeira, Bruno S.Zukowski, Cleverson N.Oliveira, Ricardo G. G. deRibeiro, Noara B.Moraes, Jeffer L. dePetriz, João L. F.Pimentel, Adriana M.Miranda, Jacqueline S.Abufaiad, Bárbara E. de JesusGibson, MichaelGranger, Christopher B.Alexander, John H.Souza, Olga F. deBRACE CORONA Investigators2021-03-05T17:02:53Z2021-03-05T17:02:53Z2021LOPES, Renato D. et al. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA, v. 325, n. 3, p. 254-264, 2021.0098-7484https://www.arca.fiocruz.br/handle/icict/4627710.1001/jama.2020.25864engAmerican Medical AssociationEffect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleD'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Duke University Medical Center. Duke Clinical Research Institute. Durham, North Carolina, USA / Brazilian Clinical Research Institute. São Paulo, SP, Brazil / Rede D'Or São Luiz. São Paulo, SP, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Hospital São Luiz Jabaquara. São Paulo, SP, Brazil / Santa Casa de São Paulo, São Paulo, SP, Brazil.Brazilian Clinical Research Institute. São Paulo, SP, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.Brazilian Clinical Research Institute. São Paulo, SP, Brazil / Insper Institute of Education and Research. São Paulo, SP, Brazil.Brazilian Clinical Research Institute. São Paulo, SP, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Hospital São Luiz Anália Franco. São Paulo, SP, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Hospital São Luiz São Caetano. São Caetano do Sul, SP, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. São Paulo, SP, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Hospital São Luiz Jabaquara. São Paulo, SP, Brazil.Hospital Villa Lobos. São Paulo, SP, Brazil.Hospital São Luiz Anália Franco. São Paulo, SP, Brazil.Hospital São Rafael. Salvador, BA, Brazil / Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brazil.Hospital São Rafael. Salvador, BA, Brazil.Hospital São Luiz Anália Franco. São Paulo, SP, Brazil.Hospital SinoBrasileiro. Osasco, SP, Brazil.Hospital SinoBrasileiro. Osasco, SP, Brazil.Hospital São Luiz Morumbi. São Paulo, SP, Brazil.Hospital São Luiz Morumbi. São Paulo, SP, Brazil.Hospital Caxias D'Or. Duque de Caxias, RJ, Brazil.Hospital Copa D'Or. Rio de Janeiro, RJ, Brazil.Hospital Quinta D'Or. Rio de Janeiro, RJ, Brazil.Hospital Santa Luzia. Brasília, DF, Brazil.Hospital Assunção. São Bernardo do Campo, SP, Brazil.Hospital Barra D'Or. Rio de Janeiro, RJ, Brazil.Hospital Niterói D'Or. Niterói, RJ, Brazil.Hospital Copa Star. Rio de Janeiro, RJ, Brazil.Hospital Oeste D'Or. Rio de Janeiro, RJ, Brazil.Harvard University. Harvard Medical School. Boston, Massachusetts, USA.Duke University Medical Center. Duke Clinical Research Institute. Durham, North Carolina, USA.Duke University Medical Center. Duke Clinical Research Institute. Durham, North Carolina, USA.D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. São Paulo, SP, Brazil / Hospital Copa Star. Rio de Janeiro, RJ, Brazil.Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, setting, and participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main outcomes and measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment.COVID-19Angiotensin-converting enzyme inhibitors (ACEIs)Angiotensin II receptor blockers (ARBs)info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/46277/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALEffect_Andrea_Sousa_etal_INI_2021.pdfEffect_Andrea_Sousa_etal_INI_2021.pdfapplication/pdf461361https://www.arca.fiocruz.br/bitstream/icict/46277/2/Effect_Andrea_Sousa_etal_INI_2021.pdfde93a08159c7a2e2afb733bd65aaf925MD52TEXTEffect_Andrea_Sousa_etal_INI_2021.pdf.txtEffect_Andrea_Sousa_etal_INI_2021.pdf.txtExtracted 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| dc.title.pt_BR.fl_str_mv |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| title |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| spellingShingle |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial Lopes, Renato D. COVID-19 Angiotensin-converting enzyme inhibitors (ACEIs) Angiotensin II receptor blockers (ARBs) |
| title_short |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| title_full |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| title_fullStr |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| title_full_unstemmed |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| title_sort |
Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial |
| author |
Lopes, Renato D. |
| author_facet |
Lopes, Renato D. Macedo, Ariane V. S. Barros-E-Silva, Pedro G. M. de Moll-Bernardes, Renata J. Santos, Tiago M. dos Mazza, Lilian Feldman, André Arruda, Guilherme D'Andréa Saba Albuquerque, Denílson C. de Camiletti, Angelina S. Sousa, Andréa S. de Paula, Thiago C. de Giusti, Karla G. D. Domiciano, Rafael A. M. Noya-Rabelo, Márcia M. Hamilton, Alan M. Loures, Vitor A. Dionísio, Rodrigo M. Furquim, Thyago A. B. De Luca, Fábio A. Sousa, Ítalo B. dos Santos Bandeira, Bruno S. Zukowski, Cleverson N. Oliveira, Ricardo G. G. de Ribeiro, Noara B. Moraes, Jeffer L. de Petriz, João L. F. Pimentel, Adriana M. Miranda, Jacqueline S. Abufaiad, Bárbara E. de Jesus Gibson, Michael Granger, Christopher B. Alexander, John H. Souza, Olga F. de BRACE CORONA Investigators |
| author_role |
author |
| author2 |
Macedo, Ariane V. S. Barros-E-Silva, Pedro G. M. de Moll-Bernardes, Renata J. Santos, Tiago M. dos Mazza, Lilian Feldman, André Arruda, Guilherme D'Andréa Saba Albuquerque, Denílson C. de Camiletti, Angelina S. Sousa, Andréa S. de Paula, Thiago C. de Giusti, Karla G. D. Domiciano, Rafael A. M. Noya-Rabelo, Márcia M. Hamilton, Alan M. Loures, Vitor A. Dionísio, Rodrigo M. Furquim, Thyago A. B. De Luca, Fábio A. Sousa, Ítalo B. dos Santos Bandeira, Bruno S. Zukowski, Cleverson N. Oliveira, Ricardo G. G. de Ribeiro, Noara B. Moraes, Jeffer L. de Petriz, João L. F. Pimentel, Adriana M. Miranda, Jacqueline S. Abufaiad, Bárbara E. de Jesus Gibson, Michael Granger, Christopher B. Alexander, John H. Souza, Olga F. de BRACE CORONA Investigators |
| 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 author author |
| dc.contributor.author.fl_str_mv |
Lopes, Renato D. Macedo, Ariane V. S. Barros-E-Silva, Pedro G. M. de Moll-Bernardes, Renata J. Santos, Tiago M. dos Mazza, Lilian Feldman, André Arruda, Guilherme D'Andréa Saba Albuquerque, Denílson C. de Camiletti, Angelina S. Sousa, Andréa S. de Paula, Thiago C. de Giusti, Karla G. D. Domiciano, Rafael A. M. Noya-Rabelo, Márcia M. Hamilton, Alan M. Loures, Vitor A. Dionísio, Rodrigo M. Furquim, Thyago A. B. De Luca, Fábio A. Sousa, Ítalo B. dos Santos Bandeira, Bruno S. Zukowski, Cleverson N. Oliveira, Ricardo G. G. de Ribeiro, Noara B. Moraes, Jeffer L. de Petriz, João L. F. Pimentel, Adriana M. Miranda, Jacqueline S. Abufaiad, Bárbara E. de Jesus Gibson, Michael Granger, Christopher B. Alexander, John H. Souza, Olga F. de BRACE CORONA Investigators |
| dc.subject.en.pt_BR.fl_str_mv |
COVID-19 Angiotensin-converting enzyme inhibitors (ACEIs) Angiotensin II receptor blockers (ARBs) |
| topic |
COVID-19 Angiotensin-converting enzyme inhibitors (ACEIs) Angiotensin II receptor blockers (ARBs) |
| description |
D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil / Duke University Medical Center. Duke Clinical Research Institute. Durham, North Carolina, USA / Brazilian Clinical Research Institute. São Paulo, SP, Brazil / Rede D'Or São Luiz. São Paulo, SP, Brazil. |
| publishDate |
2021 |
| dc.date.accessioned.fl_str_mv |
2021-03-05T17:02:53Z |
| dc.date.available.fl_str_mv |
2021-03-05T17:02:53Z |
| dc.date.issued.fl_str_mv |
2021 |
| dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
| dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.citation.fl_str_mv |
LOPES, Renato D. et al. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA, v. 325, n. 3, p. 254-264, 2021. |
| dc.identifier.uri.fl_str_mv |
https://www.arca.fiocruz.br/handle/icict/46277 |
| dc.identifier.issn.pt_BR.fl_str_mv |
0098-7484 |
| dc.identifier.doi.none.fl_str_mv |
10.1001/jama.2020.25864 |
| identifier_str_mv |
LOPES, Renato D. et al. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA, v. 325, n. 3, p. 254-264, 2021. 0098-7484 10.1001/jama.2020.25864 |
| url |
https://www.arca.fiocruz.br/handle/icict/46277 |
| dc.language.iso.fl_str_mv |
eng |
| language |
eng |
| dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
| eu_rights_str_mv |
openAccess |
| dc.publisher.none.fl_str_mv |
American Medical Association |
| publisher.none.fl_str_mv |
American Medical Association |
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reponame:Repositório Institucional da FIOCRUZ (ARCA) instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
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Fundação Oswaldo Cruz (FIOCRUZ) |
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FIOCRUZ |
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FIOCRUZ |
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Repositório Institucional da FIOCRUZ (ARCA) |
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Repositório Institucional da FIOCRUZ (ARCA) |
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https://www.arca.fiocruz.br/bitstream/icict/46277/1/license.txt https://www.arca.fiocruz.br/bitstream/icict/46277/2/Effect_Andrea_Sousa_etal_INI_2021.pdf https://www.arca.fiocruz.br/bitstream/icict/46277/3/Effect_Andrea_Sousa_etal_INI_2021.pdf.txt |
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MD5 MD5 MD5 |
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Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ) |
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repositorio.arca@fiocruz.br |
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