Current best evidence for clinical care (more info)
BACKGROUND: The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in coronavirus disease 2019 (COVID-19) susceptibility, severity, and treatment is unclear.
PURPOSE: To evaluate, on an ongoing basis, whether use of ACEIs or ARBs either increases risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or is associated with worse COVID-19 disease outcomes, and to assess the efficacy of these medications for COVID-19 treatment.
DATA SOURCES: MEDLINE (Ovid) and Cochrane Database of Systematic Reviews from 2003 to 4 May 2020, with planned ongoing surveillance for 1 year; the World Health Organization database of COVID-19 publications and medRxiv.org through 17 April 2020; and ClinicalTrials.gov to 24 April 2020, with planned ongoing surveillance.
STUDY SELECTION: Observational studies and trials in adults that examined associations and effects of ACEIs or ARBs on risk for SARS-CoV-2 infection and COVID-19 disease severity and mortality.
DATA EXTRACTION: Single-reviewer abstraction confirmed by another reviewer, independent evaluation by 2 reviewers of study quality, and collective assessment of certainty of evidence.
DATA SYNTHESIS: Two retrospective cohort studies found that ACEI and ARB use was not associated with a higher likelihood of receiving a positive SARS-CoV-2 test result, and 1 case-control study found no association with COVID-19 illness in a large community (moderate-certainty evidence). Fourteen observational studies, involving a total of 23 565 adults with COVID-19, showed consistent evidence that neither medication was associated with more severe COVID-19 illness (high-certainty evidence). Four registered randomized trials plan to evaluate ACEIs and ARBs for treatment of COVID-19.
LIMITATION: Half the studies were small and did not adjust for important confounding variables.
CONCLUSION: High-certainty evidence suggests that ACEI or ARB use is not associated with more severe COVID-19 disease, and moderate-certainty evidence suggests no association between use of these medications and positive SARS-CoV-2 test results among symptomatic patients. Whether these medications increase the risk for mild or asymptomatic disease or are beneficial in COVID-19 treatment remains uncertain.
PRIMARY FUNDING SOURCE: None. (PROSPERO: registration number pending).
| Discipline / Specialty Area | Score |
|---|---|
| General Internal Medicine-Primary Care(US) | |
| Family Medicine (FM)/General Practice (GP) | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Cardiology | |
| Infectious Disease | |
| Intensivist/Critical Care | |
| Emergency Medicine | |
As an ER doc in the era of Covid, we are beginning to know a little more. This article is a decent meta-analysis that helps eliminate some uncertainty.
This study addresses one of the many concerns in the Covid-19 pandemic. The evidence highlighted clarifies the safety of ACEi/ARB in the studied population. Although speculations about Covid-19 infection and related presentations are rife, these studies are important for ensuring safety in this subset of patients.
Although there is a need for stroger evidence, the results of this study will guide the use of ACEIs and ARBs during the ongoing COVID 19 pandemic.
Useful review addressing an early COVID myth in a methodologically sound manner that produced clinically applicable results.