No association between use of ACE inhibitors or angiotensin II receptor blockers prior to hospital admission and clinical course of COVID‐19 in the COvid MEdicaTion (COMET) study

• Published in: British Journal of Clinical Pharmacology 2021
• Main Authors: Roos S.G. Sablerolles, Freija E.F. Hogenhuis, Lafeber, Melvin, Bob P.A. van de Loo, Borgsteede, Sander D, Boersma, Eric, Versmissen, Jorie, van der Kuy, Hugo
• Format: Web Resource
• Language: English
• DOI: 10.1111/bcp.14751

Since the outbreak of SARS‐CoV‐2, also known as COVID‐19, conflicting theories have circulated on the influence of angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) on incidence and clinical course of COVID‐19, but data are scarce. The COvid MEdicaTion (COMET) study is an observational, multinational study that focused on the clinical course of COVID‐19 (i.e. hospital mortality and ICU admission), and included COVID‐19 patients who were registered at the emergency department or admitted to clinical wards of 63 participating hospitals. Pharmacists, clinical pharmacologists or treating physicians collected data on medication prescribed prior to admission. The association between the medication and composite clinical endpoint, including mortality and intensive care unit (ICU) admission, was analysed by multivariable logistic regression models to adjust for potential confounders. A total of 4870 patients were enrolled. ACEi were used by 847 (17.4%) patients and ARB by 761 (15.6%) patients. No significant association was seen with ACEi and the composite endpoint (adjusted odds ratio (OR) 0.94; 95%confidence interval (CI) 0.79 to 1.12), mortality (OR 1.03; 95%CI 0.84 to 1.27) or ICU admission (OR 0.96; 95%CI 0.78 to 1.19) after adjustment for covariates. Similarly, no association was observed between ARB and the composite endpoint (OR 1.09; 95%OR 0.90 to 1.30), mortality (OR 1.12; OR 0.90 to 1.39) or ICU admission (OR 1.21; 95%CI 0.98 to 1.49). In conclusion, we found no evidence of a harmful or beneficial effect of ACEi or ARB use prior to hospital admission on ICU admission or hospital mortality.