Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial
Summary: Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adap...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | iScience |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S258900422302223X |
| _version_ | 1797659739404894208 |
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| author | Vincent Rathkolb Marianna T. Traugott Andreas Heinzel Marko Poglitsch Judith Aberle Farsad Eskandary Agnes Abrahamowicz Martin Mueller Petra Knollmueller Tarik Shoumariyeh Jasmin Stuflesser Ivan Seeber Georg Gibas Hannah Mayfurth Viktoria Tinhof Lukas Schmoelz Markus Zeitlinger Christian Schoergenhofer Bernd Jilma Bernd Genser Wolfgang Hoepler Sara Omid Mario Karolyi Christoph Wenisch Rainer Oberbauer Alexander Zoufaly Manfred Hecking Roman Reindl-Schwaighofer |
| author_facet | Vincent Rathkolb Marianna T. Traugott Andreas Heinzel Marko Poglitsch Judith Aberle Farsad Eskandary Agnes Abrahamowicz Martin Mueller Petra Knollmueller Tarik Shoumariyeh Jasmin Stuflesser Ivan Seeber Georg Gibas Hannah Mayfurth Viktoria Tinhof Lukas Schmoelz Markus Zeitlinger Christian Schoergenhofer Bernd Jilma Bernd Genser Wolfgang Hoepler Sara Omid Mario Karolyi Christoph Wenisch Rainer Oberbauer Alexander Zoufaly Manfred Hecking Roman Reindl-Schwaighofer |
| author_sort | Vincent Rathkolb |
| collection | DOAJ |
| description | Summary: Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adaptive Clinical Trial (ACOVACT), patients with hypertension and COVID-19 were randomized 1:1 to either RASi continuation (n = 30) or switch to a non-RASi medication (n = 29). RAS metabolites were analyzed using a mixed linear regression model (n = 30). Time to a sustained clinical improvement was equal and ACE2 did not differ between the groups but increased over time in both. Overall ACE2 was higher with severe COVID-19. ACE-S and Ang II levels increased as expected with ACE inhibitor discontinuation. These data support the safety of RASi continuation in COVID-19, although RASi were frequently discontinued in our post hoc analysis. The study was not powered to draw definite conclusions on clinical outcomes using small sample sizes. |
| first_indexed | 2024-03-11T18:19:27Z |
| format | Article |
| id | doaj.art-cde4c1a923a34b2a9fa80a213f0e9c8c |
| institution | Directory Open Access Journal |
| issn | 2589-0042 |
| language | English |
| last_indexed | 2024-03-11T18:19:27Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | iScience |
| spelling | doaj.art-cde4c1a923a34b2a9fa80a213f0e9c8c2023-10-16T04:12:46ZengElsevieriScience2589-00422023-11-012611108146Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trialVincent Rathkolb0Marianna T. Traugott1Andreas Heinzel2Marko Poglitsch3Judith Aberle4Farsad Eskandary5Agnes Abrahamowicz6Martin Mueller7Petra Knollmueller8Tarik Shoumariyeh9Jasmin Stuflesser10Ivan Seeber11Georg Gibas12Hannah Mayfurth13Viktoria Tinhof14Lukas Schmoelz15Markus Zeitlinger16Christian Schoergenhofer17Bernd Jilma18Bernd Genser19Wolfgang Hoepler20Sara Omid21Mario Karolyi22Christoph Wenisch23Rainer Oberbauer24Alexander Zoufaly25Manfred Hecking26Roman Reindl-Schwaighofer27Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaAttoquant Diagnostics, Vienna, AustriaInstitute of Virology, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, Wien, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, Wien, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, Wien, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, Wien, AustriaCenter for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, GermanyDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaDepartment of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, AustriaDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria; Corresponding authorDepartment of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, AustriaSummary: Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adaptive Clinical Trial (ACOVACT), patients with hypertension and COVID-19 were randomized 1:1 to either RASi continuation (n = 30) or switch to a non-RASi medication (n = 29). RAS metabolites were analyzed using a mixed linear regression model (n = 30). Time to a sustained clinical improvement was equal and ACE2 did not differ between the groups but increased over time in both. Overall ACE2 was higher with severe COVID-19. ACE-S and Ang II levels increased as expected with ACE inhibitor discontinuation. These data support the safety of RASi continuation in COVID-19, although RASi were frequently discontinued in our post hoc analysis. The study was not powered to draw definite conclusions on clinical outcomes using small sample sizes.http://www.sciencedirect.com/science/article/pii/S258900422302223XVirologyHuman metabolism |
| spellingShingle | Vincent Rathkolb Marianna T. Traugott Andreas Heinzel Marko Poglitsch Judith Aberle Farsad Eskandary Agnes Abrahamowicz Martin Mueller Petra Knollmueller Tarik Shoumariyeh Jasmin Stuflesser Ivan Seeber Georg Gibas Hannah Mayfurth Viktoria Tinhof Lukas Schmoelz Markus Zeitlinger Christian Schoergenhofer Bernd Jilma Bernd Genser Wolfgang Hoepler Sara Omid Mario Karolyi Christoph Wenisch Rainer Oberbauer Alexander Zoufaly Manfred Hecking Roman Reindl-Schwaighofer Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial iScience Virology Human metabolism |
| title | Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial |
| title_full | Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial |
| title_fullStr | Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial |
| title_full_unstemmed | Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial |
| title_short | Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial |
| title_sort | renin angiotensin system inhibitor discontinuation in covid 19 did not modify systemic ace2 in a randomized controlled trial |
| topic | Virology Human metabolism |
| url | http://www.sciencedirect.com/science/article/pii/S258900422302223X |
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