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The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on death and severity of disease in patients with coronavirus disease 2019 (COVID-19): A meta-analysis
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  • Jagat Mukherjee,
  • Binayak Sinha,
  • Kalyan Gangopadhyay
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Jagat Mukherjee
Apollo Gleneagles Hospital
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Binayak Sinha
AMRI Hospitals
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Kalyan Gangopadhyay
Fortis Hospital Anandapur
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Aims and Methods: Effect of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on outcomes in patients with coronavirus disease 2019 (COVID-19) is uncertain. Available evidence is limited to a few retrospective observational studies with small number of patients. We did a meta-analysis to assess the effect of ACEi/ARB in patients with COVID-19 on severity of disease, risk for hospitalisation, and death compared to those not on ACEi/ARB. We searched the Cochrane library, PubMed, Embase, ClinicalTrial.gov and medRxiv for studies published until 25.04.2020. Inclusion criteria included all studies with patients with confirmed COVID-19 either taking, or not taking, ACEi/ARB. Depending on degree of heterogeneity, fixed or random effect model was selected to calculate effect size (Odds ratio). Results: Six studies were eligible for this meta-analysis. These included 423 patients on ACEi/ARB, and 1419 not on ACEi/ARB. Compared to patients with COVID-19 not on ACEi/ARB, there was a statistically significant 43% reduction (OR 0.57, CI: 0.37-0.88, I2: 0.000) in the odds of death in those on ACEi/ARB. There was a statistically non-significant 38% reduction (OR: 0.62, 95% CI: 0.31-1.23, I2=70.36) in the odds of developing severe disease and 19% reduction (OR 0.81; 95% CI: 0.42-1.55, I2: 0.000) in the odds of hospitalisation among those on ACEi/ARB. Discussion: It is safe to use ACEi/ARB in patients with COVID-19 requiring these medications for associated comorbidities. Although limited by confounding factors typical of a meta-analysis of retrospective observational studies, our data suggests that use of these medications may reduce the odds of death. Conclusion: Our meta-analysis of the updated studies on SARS-CoV-2 reassures the medical fraternity on the use of and continuation of ACEi/ARB, supporting all recent recommendations .

Peer review status:UNDER REVIEW

28 Apr 2020Submitted to International Journal of Clinical Practice
28 Apr 2020Assigned to Editor
28 Apr 2020Submission Checks Completed
29 Apr 2020Reviewer(s) Assigned
18 Sep 2020Review(s) Completed, Editorial Evaluation Pending