Results from the BRACE-CORONA trial, the first randomized trial to address the question of whether patients with COVID-19 should continue to take angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs), were published online in JAMA on January 19, 2021. 

In this study, Lopes et al attempted to ascertain whether discontinuation compared with continuation of ACEIs or ARBs altered the number of days alive and out of the hospital through 30 days in those patients with mild-to-moderate COVID-19. The researchers conducted 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). 

The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes consisted of death, cardiovascular death, and COVID-19 progression. Researchers found that among 659 patients, the average 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 average 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 classified as moderate. 

The results indicated that there was no substantial variance 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 noteworthy variance 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 reported 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%).

Lopes et al concluded that in patients hospitalized with mild-to-moderate COVID-19 taking ACEIs or ARBs prior to hospital admission there was no substantial variance in the average number of days alive and out of the hospital for those assigned to discontinue versus continuing these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild-to-moderate COVID-19 when there is an indication for treatment.

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