Key result
Exposure to RAAS inhibitors was not associated with higher risks for SARS-CoV-2 infection or poor COVID-19 disease prognosis, supporting their continued use in patients with existing clinical needs.
Why the study?
Because RAAS inhibitors increase ACE2, concerns were raised regarding increased risks of SARS-CoV-2 infection and poor COVID-19 prognosis in persons taking these medications.
Does the use of RAAS inhibitors increase the risk of SARS-CoV-2 infection or worsen COVID-19 prognosis in patients?
Systematic Review
Does the use of RAAS inhibitors increase the risk of SARS-CoV-2 infection or worsen COVID-19 prognosis in patients?
The use of RAAS inhibitors is not associated with an increased risk of SARS-CoV-2 infection or worse COVID-19 prognosis, supporting their continued use in patients with existing indications.
Answers are grounded in this paper and cite their sources.
Supports continued RAAS inhibitor use in indicated patients; reinforces cardiology society guidance on COVID-19 safety.
BACKGROUND: Angiotensin-converting-enzyme-2, being the receptor for SARS-CoV-2, is increased in the use of RAAS inhibitors. Therefore, concerns have been raised over risks of SARS-CoV-2 infection and poor prognosis of COVID-19 in persons with prior exposure to these drugs. This study aimed to systematically review available evidence for associations between exposure to RAAS inhibitors with susceptibility to SARS-CoV-2 infection and clinical outcomes in infected persons. It hopes to address the question on the effects of RAAS inhibitors on the risk of COVID-19 and its prognosis. MAIN BODY: Search was conducted in the databases of PubMed, Scopus, Cochrane, Embase and MedRxiv.org from December 2019 to May 31, 2020, using relevant keywords. Additional articles were identified through hand-searching of reference lists. Studies that reported associations between positive tests to COVID-19 and use of RAAS inhibitors, and treatment outcomes of COVID-19 patients who had exposure to RAAS inhibitors were considered eligible. The Newcastle-Ottawa scale was used to assess risk of bias in individual studies. The review was conducted in line with Preferred Regulatory Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2009. From the 952 studies screened and 2 studies from reference hand-searching, 18 were reviewed. Four studies evaluated the risks for SARS-CoV-2 infection among RAAS inhibitors users, and 16 (including 2 of the 4 studies) evaluated the clinical outcomes associated with previous exposure to RAAS inhibitors. CONCLUSION: Evidence does not suggest higher risks for SARS-CoV-2 infection or poor disease prognosis in the use of RAAS inhibitors. This suggests the continued use of RAAS inhibitors by patients with existing needs, which supports the position statements of American Heart Association and European societies for Cardiology. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43094-021-00224-4.
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Iheanacho et al. (2021) conducted a systematic review in COVID-19. RAAS inhibitors vs. No RAAS inhibitor exposure was evaluated on Risk of SARS-CoV-2 infection and COVID-19 prognosis. Exposure to RAAS inhibitors was not associated with higher risks for SARS-CoV-2 infection or poor COVID-19 disease prognosis, supporting their continued use in patients with existing clinical needs.
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