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Safety and Efficacy of Renin–Angiotensin–Aldosterone System Inhibitors in COVID-19 Population

INTRODUCTION: The safety of renin–angiotensin–aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. METHODS: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The sec...

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Detalles Bibliográficos
Autores principales: Sattar, Yasar, Mukuntharaj, Pradeeksha, Zghouzi, Mohamed, Suleiman, Abdul-Rahman M., Attique, Hassan, Ullah, Waqas, Sana, Muhammad Khawar, Zaher, Nathan, Mehmood, Maham, Doshi, Rajkumar P., Panchal, Ankur, Mir, Tanveer, Nadeem, Muhammad, Ali, Omar E., Mohamed, Mohamad, Bagur, Rodrigo, Elgendy, Islam Y., Mamas, Mamas A., Alraies, M. Chadi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237039/
https://www.ncbi.nlm.nih.gov/pubmed/34181203
http://dx.doi.org/10.1007/s40292-021-00462-w
Descripción
Sumario:INTRODUCTION: The safety of renin–angiotensin–aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. METHODS: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR). RESULTS: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99–1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93–0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79–1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97–1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes. CONCLUSIONS: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40292-021-00462-w.