Mineralocorticoid Receptor Antagonists
We did not find any eligible studies addressing the effects of mineralocorticoid receptor antagonists on pneumonia or pneumonia related death.
Renin-angiotensin system inhibitors and risk of COVID-19
Pooled result from 16 studies (Amat-Santos et al., 2020; de Abajo et al., 2020; Feng et al., 2020; Gao et al., 2020; Huang et al., 2020; Jung, Choi, You & Kim, 2020; Li, Wang, Chen, Zhang & Deng, 2020; Li et al., 2020; Mancia, Rea, Ludergnani, Apolone & Corrao, 2020; Mehta et al., 2020; Meng et al., 2020; Reynolds et al., 2020; Tan, Qiu, Xing, Ghosh, Chen & Mao, 2020; Yang et al., 2020; Zhang et al., 2020; Zhou et al., 2020), a total of 22,333 patients, showed that the risk of COVID-19 related severe adverse clinical outcomes (admission to the intensive care unit, the use of assisted ventilation, or death) was significant reduced in patients who use ACE inhibitors/ARBs (0.74, 0.56 to 0.99; p=0.04; I2=78.5%) (Figure 5). Unfortunately, few studies allow a differentiation analysis of ACE inhibitors and ARBs treatment separately. Both ACE inhibitors (0.93, 0.76 to 1.13; p=0.45; I2=60.6%) and ARB (0.96, 0.76 to 1.22; p=0.75; I2=46.9%) point to the right direction. However, these associations were not significant.
Furthermore, ten studies (Gao et al., 2020; Huang et al., 2020; Jung, Choi, You & Kim, 2020; Li, Wang, Chen, Zhang & Deng, 2020; Mehta et al., 2020; Meng et al., 2020; Tan, Qiu, Xing, Ghosh, Chen & Mao, 2020; Yang et al., 2020; Zhang et al., 2020; Zhou et al., 2020) including 11,514 patients showed that the risk of all-cause mortality among ACE inhibitors/ARBs users was significantly reduced when compared to COVID-19 patients without ACE inhibitors/ARBs treatment (odds ratio 0.59, 0.39 to 0.90; p=0.01; I2=55.1%) (Figure 6). Pooled result from four studies, five cohorts (62,243 patients) (Gnavi, Demaria, Picariello, Dalmasso, Ricceri & Costa, 2020; Mancia, Rea, Ludergnani, Apolone & Corrao, 2020; Mehta et al., 2020; Reynolds et al., 2020) showed that the risk of getting infected (whatever degree of disease - from no symptoms to severe adverse clinical outcomes) was not associated with the treatment of ACE inhibitors/ARBs (1.01, 0.85 to 1.20; p=0.91; I2=84.7%).