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Discontinuation of ARB/ACEIWiki

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Clinical Trial MeSH HPO Drug Gene SNP Protein Mutation


Correlated Drug Terms (1)


Name (Synonyms) Correlation
drug218 Continuation of ARB/ACEI Wiki 1.00

Correlated MeSH Terms (1)


Name (Synonyms) Correlation
D018352 Coronavirus Infections NIH 0.06

Correlated HPO Terms (0)


Name (Synonyms) Correlation

There is one clinical trial.

Clinical Trials


1 The Randomized Elimination or Prolongation of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Coronavirus Disease 2019

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), is associated with a high incidence of acute respiratory distress syndrome (ARDS) and death. Hypertension and cardiovascular disease are risk factors for death in COVID-19. Angiotensin converting enzyme 2 (ACE2), an important component of the renin-angiotensin system, serves as the binding site of SARS-CoV-2 and facilitates host cell entry in the lungs. In experimental models, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to increase ACE2 expression in several organs, potentially promoting viral cell invasion, although these findings are not consistent across studies. Alternatively, ACEIs and ARBs may actually improve mechanisms of host defense or hyperinflammation, ultimately reducing organ injury. Finally, ACEIs and ARBs may have direct renal, pulmonary and cardiac protective benefits in the setting of COVID-19. Therefore, it is unclear if ACEIs and ARBs may be beneficial or harmful in patients with COVID-19. Given the high prevalence of hypertension, cardiovascular and renal disease in the world, the high prevalence of ACEIs or ARBs in these conditions, and the clinical equipoise regarding the continuation vs. discontinuation of ACEIs/ARBs in the setting of COVID, a randomized trial is urgently needed. The aim of this trial is to assess the clinical impact of continuation vs. discontinuation of ACE inhibitors and angiotensin receptor blockers on outcomes in patients hospitalized with COVID-19.

NCT04338009 COVID-19 Other: Discontinuation of ARB/ACEI Other: Continuation of ARB/ACEI
MeSH:Coronavirus Infections

Primary Outcomes

Description: The primary endpoint of the trial will be a global rank score that ranks patient outcomes according to four factors: (1) time to death, (2) the number of days supported by invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), (3) the number of days supported by renal replacement therapy or pressor/inotropic therapy, and (4) a modified sequential Organ Failure Assessment (SOFA) score. The modified SOFA score will include the cardiac, respiratory, renal and coagulation domains of the SOFA score.

Measure: Hierarchical composite endpoint

Time: Up to 28 days

Secondary Outcomes

Measure: All-Cause Death

Time: Up to 28 days

Measure: Length of Hospital Stay

Time: Up to 28 days

Measure: Length of ICU Stay, invasive mechanical ventilation or extracorporeal membrane oxygenation

Time: Up to 28 days

Description: The Area Under the Curve of the modified SOFA (AUC SOFA) from daily measurements, weighted to account for the shorter observation period among patients who die in-hospital.

Measure: AUC SOFA

Time: Up to 28 days

Other Outcomes

Description: Composite

Measure: Intensive care unit admission or respiratory Failure Requiring Mechanical Ventilation.

Time: Up to 28 days

Description: Hypotension Requiring Vasopressors, inotropes or mechanical hemodynamic support (ventricular assist device or intra-aortic balloon pump).

Measure: Hypotension Requiring Vasopressors, inotropes or mechanical hemodynamic support

Time: Up to 28 days

Description: Number of days in 28-day period feee of invasive or non-invasive mechanical ventilation.

Measure: Number of 28-Day Ventilator-Free Days.

Time: Up to 28 days

Description: Difference between NT-proBNP at the time of randomization and the maximum value

Measure: Maximal change in NT-proBNP from baseline

Time: 28 days from enrollment

Description: as above

Measure: Change in serum creatinine between randomization and discharge (or time of death)

Time: Up to 28 days

Description: defined as Kidney Disease Improving Global Outcomes Stage 2 or higher or initiation of renal replacement therapy

Measure: Acute kidney injury during hospitalization

Time: Up to 28 days

Description: Proteinuria or Hematuria detected on urinalysis

Measure: Proteinuria or Hematuria

Time: Up to 28 days


No related HPO nodes (Using clinical trials)