Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19)....
Gespeichert in:
| Veröffentlicht in: | Clinical infectious diseases 2024-09, Vol.79 (3), p.615-625 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 625 |
|---|---|
| container_issue | 3 |
| container_start_page | 615 |
| container_title | Clinical infectious diseases |
| container_volume | 79 |
| creator | Tran, Karen C Asfar, Pierre Cheng, Matthew Demiselle, Julien Singer, Joel Lee, Terry Sweet, David Boyd, John Walley, Keith Haljan, Greg Sharif, Omar Geri, Guillaume Auchabie, Johann Quenot, Jean-Pierre Lee, Todd C Tsang, Jennifer Meziani, Ferhat Lamontagne, Francois Dubee, Vincent Lasocki, Sigismond Ovakim, Daniel Wood, Gordon Turgeon, Alexis Cohen, Yves Lebas, Eddy Goudelin, Marine Forrest, David Teale, Alastair Mira, Jean-Paul Fowler, Robert Daneman, Nick Adhikari, Neill K J Gousseff, Marie Leroy, Pierre Plantefeve, Gaetan Rispal, Patrick Courtois, Roxane Winston, Brent Reynolds, Steve Birks, Peter Bienvenu, Boris Tadie, Jean-Marc Talarmin, Jean-Philippe Ansart, Severine Russell, James A |
| description | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19.
Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs).
The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes.
Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.
NCT04606563. |
| doi_str_mv | 10.1093/cid/ciae306 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11426262</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3110400308</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1856-c4e27c32ac50457ef9072d537dce8be7ea0e2c84f4f2a53dbf2e00aae21729a53</originalsourceid><addsrcrecordid>eNpVkd9LHDEQx4Moaq1Pvpc8CrJ1kmz2R1_KcfUXHJyUq48Nc9lJjextzmRPaP_6xnoVJYQMM5_5ZoYvYycCPgto1bn1Xb5ICqoddii0qotKt2I3x6CbomxUc8A-pPQAIEQDep8dqFZJXZXqkP28cI7smHhwfBYSxhEHHgZ-i6OnIeevQ1r7EXv_hzruQuQTuxmJT-d3N98K0X7hE_4dhy6s_gHTMIwx9H0OF9Fj_5HtOewTHW_fI_bj8mIxvS5m86ub6WRWWNHoqrAlydoqiVZDqWtyLdSyy5t0lpol1YRA0jalK51ErbqlkwSASFLUss2ZI_b1RXe9Wa4od-UxsDfr6FcYf5uA3ryvDP7e_ApPRohSVvlkhdOtQgyPG0qjWflkqe9xoLBJRgkBJYCCJqNnL6iNIaVI7vUfAebZEpMtMVtLMv3p7Wiv7H8P1F_T1Ijz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3110400308</pqid></control><display><type>article</type><title>Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Tran, Karen C ; Asfar, Pierre ; Cheng, Matthew ; Demiselle, Julien ; Singer, Joel ; Lee, Terry ; Sweet, David ; Boyd, John ; Walley, Keith ; Haljan, Greg ; Sharif, Omar ; Geri, Guillaume ; Auchabie, Johann ; Quenot, Jean-Pierre ; Lee, Todd C ; Tsang, Jennifer ; Meziani, Ferhat ; Lamontagne, Francois ; Dubee, Vincent ; Lasocki, Sigismond ; Ovakim, Daniel ; Wood, Gordon ; Turgeon, Alexis ; Cohen, Yves ; Lebas, Eddy ; Goudelin, Marine ; Forrest, David ; Teale, Alastair ; Mira, Jean-Paul ; Fowler, Robert ; Daneman, Nick ; Adhikari, Neill K J ; Gousseff, Marie ; Leroy, Pierre ; Plantefeve, Gaetan ; Rispal, Patrick ; Courtois, Roxane ; Winston, Brent ; Reynolds, Steve ; Birks, Peter ; Bienvenu, Boris ; Tadie, Jean-Marc ; Talarmin, Jean-Philippe ; Ansart, Severine ; Russell, James A</creator><creatorcontrib>Tran, Karen C ; Asfar, Pierre ; Cheng, Matthew ; Demiselle, Julien ; Singer, Joel ; Lee, Terry ; Sweet, David ; Boyd, John ; Walley, Keith ; Haljan, Greg ; Sharif, Omar ; Geri, Guillaume ; Auchabie, Johann ; Quenot, Jean-Pierre ; Lee, Todd C ; Tsang, Jennifer ; Meziani, Ferhat ; Lamontagne, Francois ; Dubee, Vincent ; Lasocki, Sigismond ; Ovakim, Daniel ; Wood, Gordon ; Turgeon, Alexis ; Cohen, Yves ; Lebas, Eddy ; Goudelin, Marine ; Forrest, David ; Teale, Alastair ; Mira, Jean-Paul ; Fowler, Robert ; Daneman, Nick ; Adhikari, Neill K J ; Gousseff, Marie ; Leroy, Pierre ; Plantefeve, Gaetan ; Rispal, Patrick ; Courtois, Roxane ; Winston, Brent ; Reynolds, Steve ; Birks, Peter ; Bienvenu, Boris ; Tadie, Jean-Marc ; Talarmin, Jean-Philippe ; Ansart, Severine ; Russell, James A ; ARBs CORONA II Team ; for the ARBs CORONA II Team</creatorcontrib><description>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19.
Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs).
The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes.
Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.
NCT04606563.</description><identifier>ISSN: 1058-4838</identifier><identifier>ISSN: 1537-6591</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciae306</identifier><identifier>PMID: 39325643</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Angiotensin II Type 1 Receptor Blockers - administration & dosage ; Angiotensin II Type 1 Receptor Blockers - adverse effects ; Angiotensin II Type 1 Receptor Blockers - therapeutic use ; Canada - epidemiology ; COVID-19 - mortality ; COVID-19 Drug Treatment ; Female ; France - epidemiology ; Hospital Mortality ; Hospitalization ; Humans ; Hypotension - chemically induced ; Losartan - administration & dosage ; Losartan - adverse effects ; Losartan - therapeutic use ; Major ; Male ; Middle Aged ; SARS-CoV-2 - drug effects ; Treatment Outcome</subject><ispartof>Clinical infectious diseases, 2024-09, Vol.79 (3), p.615-625</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1856-c4e27c32ac50457ef9072d537dce8be7ea0e2c84f4f2a53dbf2e00aae21729a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39325643$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tran, Karen C</creatorcontrib><creatorcontrib>Asfar, Pierre</creatorcontrib><creatorcontrib>Cheng, Matthew</creatorcontrib><creatorcontrib>Demiselle, Julien</creatorcontrib><creatorcontrib>Singer, Joel</creatorcontrib><creatorcontrib>Lee, Terry</creatorcontrib><creatorcontrib>Sweet, David</creatorcontrib><creatorcontrib>Boyd, John</creatorcontrib><creatorcontrib>Walley, Keith</creatorcontrib><creatorcontrib>Haljan, Greg</creatorcontrib><creatorcontrib>Sharif, Omar</creatorcontrib><creatorcontrib>Geri, Guillaume</creatorcontrib><creatorcontrib>Auchabie, Johann</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Lee, Todd C</creatorcontrib><creatorcontrib>Tsang, Jennifer</creatorcontrib><creatorcontrib>Meziani, Ferhat</creatorcontrib><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Dubee, Vincent</creatorcontrib><creatorcontrib>Lasocki, Sigismond</creatorcontrib><creatorcontrib>Ovakim, Daniel</creatorcontrib><creatorcontrib>Wood, Gordon</creatorcontrib><creatorcontrib>Turgeon, Alexis</creatorcontrib><creatorcontrib>Cohen, Yves</creatorcontrib><creatorcontrib>Lebas, Eddy</creatorcontrib><creatorcontrib>Goudelin, Marine</creatorcontrib><creatorcontrib>Forrest, David</creatorcontrib><creatorcontrib>Teale, Alastair</creatorcontrib><creatorcontrib>Mira, Jean-Paul</creatorcontrib><creatorcontrib>Fowler, Robert</creatorcontrib><creatorcontrib>Daneman, Nick</creatorcontrib><creatorcontrib>Adhikari, Neill K J</creatorcontrib><creatorcontrib>Gousseff, Marie</creatorcontrib><creatorcontrib>Leroy, Pierre</creatorcontrib><creatorcontrib>Plantefeve, Gaetan</creatorcontrib><creatorcontrib>Rispal, Patrick</creatorcontrib><creatorcontrib>Courtois, Roxane</creatorcontrib><creatorcontrib>Winston, Brent</creatorcontrib><creatorcontrib>Reynolds, Steve</creatorcontrib><creatorcontrib>Birks, Peter</creatorcontrib><creatorcontrib>Bienvenu, Boris</creatorcontrib><creatorcontrib>Tadie, Jean-Marc</creatorcontrib><creatorcontrib>Talarmin, Jean-Philippe</creatorcontrib><creatorcontrib>Ansart, Severine</creatorcontrib><creatorcontrib>Russell, James A</creatorcontrib><creatorcontrib>ARBs CORONA II Team</creatorcontrib><creatorcontrib>for the ARBs CORONA II Team</creatorcontrib><title>Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19.
Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs).
The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes.
Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.
NCT04606563.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiotensin II Type 1 Receptor Blockers - administration & dosage</subject><subject>Angiotensin II Type 1 Receptor Blockers - adverse effects</subject><subject>Angiotensin II Type 1 Receptor Blockers - therapeutic use</subject><subject>Canada - epidemiology</subject><subject>COVID-19 - mortality</subject><subject>COVID-19 Drug Treatment</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypotension - chemically induced</subject><subject>Losartan - administration & dosage</subject><subject>Losartan - adverse effects</subject><subject>Losartan - therapeutic use</subject><subject>Major</subject><subject>Male</subject><subject>Middle Aged</subject><subject>SARS-CoV-2 - drug effects</subject><subject>Treatment Outcome</subject><issn>1058-4838</issn><issn>1537-6591</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkd9LHDEQx4Moaq1Pvpc8CrJ1kmz2R1_KcfUXHJyUq48Nc9lJjextzmRPaP_6xnoVJYQMM5_5ZoYvYycCPgto1bn1Xb5ICqoddii0qotKt2I3x6CbomxUc8A-pPQAIEQDep8dqFZJXZXqkP28cI7smHhwfBYSxhEHHgZ-i6OnIeevQ1r7EXv_hzruQuQTuxmJT-d3N98K0X7hE_4dhy6s_gHTMIwx9H0OF9Fj_5HtOewTHW_fI_bj8mIxvS5m86ub6WRWWNHoqrAlydoqiVZDqWtyLdSyy5t0lpol1YRA0jalK51ErbqlkwSASFLUss2ZI_b1RXe9Wa4od-UxsDfr6FcYf5uA3ryvDP7e_ApPRohSVvlkhdOtQgyPG0qjWflkqe9xoLBJRgkBJYCCJqNnL6iNIaVI7vUfAebZEpMtMVtLMv3p7Wiv7H8P1F_T1Ijz</recordid><startdate>20240926</startdate><enddate>20240926</enddate><creator>Tran, Karen C</creator><creator>Asfar, Pierre</creator><creator>Cheng, Matthew</creator><creator>Demiselle, Julien</creator><creator>Singer, Joel</creator><creator>Lee, Terry</creator><creator>Sweet, David</creator><creator>Boyd, John</creator><creator>Walley, Keith</creator><creator>Haljan, Greg</creator><creator>Sharif, Omar</creator><creator>Geri, Guillaume</creator><creator>Auchabie, Johann</creator><creator>Quenot, Jean-Pierre</creator><creator>Lee, Todd C</creator><creator>Tsang, Jennifer</creator><creator>Meziani, Ferhat</creator><creator>Lamontagne, Francois</creator><creator>Dubee, Vincent</creator><creator>Lasocki, Sigismond</creator><creator>Ovakim, Daniel</creator><creator>Wood, Gordon</creator><creator>Turgeon, Alexis</creator><creator>Cohen, Yves</creator><creator>Lebas, Eddy</creator><creator>Goudelin, Marine</creator><creator>Forrest, David</creator><creator>Teale, Alastair</creator><creator>Mira, Jean-Paul</creator><creator>Fowler, Robert</creator><creator>Daneman, Nick</creator><creator>Adhikari, Neill K J</creator><creator>Gousseff, Marie</creator><creator>Leroy, Pierre</creator><creator>Plantefeve, Gaetan</creator><creator>Rispal, Patrick</creator><creator>Courtois, Roxane</creator><creator>Winston, Brent</creator><creator>Reynolds, Steve</creator><creator>Birks, Peter</creator><creator>Bienvenu, Boris</creator><creator>Tadie, Jean-Marc</creator><creator>Talarmin, Jean-Philippe</creator><creator>Ansart, Severine</creator><creator>Russell, James A</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240926</creationdate><title>Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial</title><author>Tran, Karen C ; Asfar, Pierre ; Cheng, Matthew ; Demiselle, Julien ; Singer, Joel ; Lee, Terry ; Sweet, David ; Boyd, John ; Walley, Keith ; Haljan, Greg ; Sharif, Omar ; Geri, Guillaume ; Auchabie, Johann ; Quenot, Jean-Pierre ; Lee, Todd C ; Tsang, Jennifer ; Meziani, Ferhat ; Lamontagne, Francois ; Dubee, Vincent ; Lasocki, Sigismond ; Ovakim, Daniel ; Wood, Gordon ; Turgeon, Alexis ; Cohen, Yves ; Lebas, Eddy ; Goudelin, Marine ; Forrest, David ; Teale, Alastair ; Mira, Jean-Paul ; Fowler, Robert ; Daneman, Nick ; Adhikari, Neill K J ; Gousseff, Marie ; Leroy, Pierre ; Plantefeve, Gaetan ; Rispal, Patrick ; Courtois, Roxane ; Winston, Brent ; Reynolds, Steve ; Birks, Peter ; Bienvenu, Boris ; Tadie, Jean-Marc ; Talarmin, Jean-Philippe ; Ansart, Severine ; Russell, James A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1856-c4e27c32ac50457ef9072d537dce8be7ea0e2c84f4f2a53dbf2e00aae21729a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiotensin II Type 1 Receptor Blockers - administration & dosage</topic><topic>Angiotensin II Type 1 Receptor Blockers - adverse effects</topic><topic>Angiotensin II Type 1 Receptor Blockers - therapeutic use</topic><topic>Canada - epidemiology</topic><topic>COVID-19 - mortality</topic><topic>COVID-19 Drug Treatment</topic><topic>Female</topic><topic>France - epidemiology</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypotension - chemically induced</topic><topic>Losartan - administration & dosage</topic><topic>Losartan - adverse effects</topic><topic>Losartan - therapeutic use</topic><topic>Major</topic><topic>Male</topic><topic>Middle Aged</topic><topic>SARS-CoV-2 - drug effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tran, Karen C</creatorcontrib><creatorcontrib>Asfar, Pierre</creatorcontrib><creatorcontrib>Cheng, Matthew</creatorcontrib><creatorcontrib>Demiselle, Julien</creatorcontrib><creatorcontrib>Singer, Joel</creatorcontrib><creatorcontrib>Lee, Terry</creatorcontrib><creatorcontrib>Sweet, David</creatorcontrib><creatorcontrib>Boyd, John</creatorcontrib><creatorcontrib>Walley, Keith</creatorcontrib><creatorcontrib>Haljan, Greg</creatorcontrib><creatorcontrib>Sharif, Omar</creatorcontrib><creatorcontrib>Geri, Guillaume</creatorcontrib><creatorcontrib>Auchabie, Johann</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Lee, Todd C</creatorcontrib><creatorcontrib>Tsang, Jennifer</creatorcontrib><creatorcontrib>Meziani, Ferhat</creatorcontrib><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Dubee, Vincent</creatorcontrib><creatorcontrib>Lasocki, Sigismond</creatorcontrib><creatorcontrib>Ovakim, Daniel</creatorcontrib><creatorcontrib>Wood, Gordon</creatorcontrib><creatorcontrib>Turgeon, Alexis</creatorcontrib><creatorcontrib>Cohen, Yves</creatorcontrib><creatorcontrib>Lebas, Eddy</creatorcontrib><creatorcontrib>Goudelin, Marine</creatorcontrib><creatorcontrib>Forrest, David</creatorcontrib><creatorcontrib>Teale, Alastair</creatorcontrib><creatorcontrib>Mira, Jean-Paul</creatorcontrib><creatorcontrib>Fowler, Robert</creatorcontrib><creatorcontrib>Daneman, Nick</creatorcontrib><creatorcontrib>Adhikari, Neill K J</creatorcontrib><creatorcontrib>Gousseff, Marie</creatorcontrib><creatorcontrib>Leroy, Pierre</creatorcontrib><creatorcontrib>Plantefeve, Gaetan</creatorcontrib><creatorcontrib>Rispal, Patrick</creatorcontrib><creatorcontrib>Courtois, Roxane</creatorcontrib><creatorcontrib>Winston, Brent</creatorcontrib><creatorcontrib>Reynolds, Steve</creatorcontrib><creatorcontrib>Birks, Peter</creatorcontrib><creatorcontrib>Bienvenu, Boris</creatorcontrib><creatorcontrib>Tadie, Jean-Marc</creatorcontrib><creatorcontrib>Talarmin, Jean-Philippe</creatorcontrib><creatorcontrib>Ansart, Severine</creatorcontrib><creatorcontrib>Russell, James A</creatorcontrib><creatorcontrib>ARBs CORONA II Team</creatorcontrib><creatorcontrib>for the ARBs CORONA II Team</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tran, Karen C</au><au>Asfar, Pierre</au><au>Cheng, Matthew</au><au>Demiselle, Julien</au><au>Singer, Joel</au><au>Lee, Terry</au><au>Sweet, David</au><au>Boyd, John</au><au>Walley, Keith</au><au>Haljan, Greg</au><au>Sharif, Omar</au><au>Geri, Guillaume</au><au>Auchabie, Johann</au><au>Quenot, Jean-Pierre</au><au>Lee, Todd C</au><au>Tsang, Jennifer</au><au>Meziani, Ferhat</au><au>Lamontagne, Francois</au><au>Dubee, Vincent</au><au>Lasocki, Sigismond</au><au>Ovakim, Daniel</au><au>Wood, Gordon</au><au>Turgeon, Alexis</au><au>Cohen, Yves</au><au>Lebas, Eddy</au><au>Goudelin, Marine</au><au>Forrest, David</au><au>Teale, Alastair</au><au>Mira, Jean-Paul</au><au>Fowler, Robert</au><au>Daneman, Nick</au><au>Adhikari, Neill K J</au><au>Gousseff, Marie</au><au>Leroy, Pierre</au><au>Plantefeve, Gaetan</au><au>Rispal, Patrick</au><au>Courtois, Roxane</au><au>Winston, Brent</au><au>Reynolds, Steve</au><au>Birks, Peter</au><au>Bienvenu, Boris</au><au>Tadie, Jean-Marc</au><au>Talarmin, Jean-Philippe</au><au>Ansart, Severine</au><au>Russell, James A</au><aucorp>ARBs CORONA II Team</aucorp><aucorp>for the ARBs CORONA II Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2024-09-26</date><risdate>2024</risdate><volume>79</volume><issue>3</issue><spage>615</spage><epage>625</epage><pages>615-625</pages><issn>1058-4838</issn><issn>1537-6591</issn><eissn>1537-6591</eissn><abstract>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19.
Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs).
The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes.
Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.
NCT04606563.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>39325643</pmid><doi>10.1093/cid/ciae306</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2024-09, Vol.79 (3), p.615-625 |
| issn | 1058-4838 1537-6591 1537-6591 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11426262 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Aged Aged, 80 and over Angiotensin II Type 1 Receptor Blockers - administration & dosage Angiotensin II Type 1 Receptor Blockers - adverse effects Angiotensin II Type 1 Receptor Blockers - therapeutic use Canada - epidemiology COVID-19 - mortality COVID-19 Drug Treatment Female France - epidemiology Hospital Mortality Hospitalization Humans Hypotension - chemically induced Losartan - administration & dosage Losartan - adverse effects Losartan - therapeutic use Major Male Middle Aged SARS-CoV-2 - drug effects Treatment Outcome |
| title | Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-12T03%3A30%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20Losartan%20on%20Patients%20Hospitalized%20for%20Acute%20COVID-19:%20A%20Randomized%20Controlled%20Trial&rft.jtitle=Clinical%20infectious%20diseases&rft.au=Tran,%20Karen%20C&rft.aucorp=ARBs%20CORONA%20II%20Team&rft.date=2024-09-26&rft.volume=79&rft.issue=3&rft.spage=615&rft.epage=625&rft.pages=615-625&rft.issn=1058-4838&rft.eissn=1537-6591&rft_id=info:doi/10.1093/cid/ciae306&rft_dat=%3Cproquest_pubme%3E3110400308%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3110400308&rft_id=info:pmid/39325643&rfr_iscdi=true |