Kidney Week

Abstract: TH-PO1154

Effect of RAAS Inhibitors in People with COVID-19: An Independent Participant Data Meta-Analysis

Session Information

• COVID-19
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Yi, Tae won, The University of British Columbia, Vancouver, British Columbia, Canada

Tae won Yi, MD, PhD

• Mallitt, Kylie-Ann, University of Sydney, Camperdown, New South Wales, Australia

Kylie-Ann Mallitt, MSc, PhD

• Wilcox, Arlen, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia

Arlen Wilcox

• Puskarich, Michael A., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States

Michael A. Puskarich, MD, MS

• Freilich, Daniel, Bassett Medical Center, Cooperstown, New York, United States

Daniel Freilich, MD

• Geriak, Matthew, Sharp Healthcare, San Diego, California, United States

Matthew Geriak, PharmD

• Shikuma, Cecilia M., University of Hawai'i at Manoa, Honolulu, Hawaii, United States

Cecilia M. Shikuma, MD

• Jardine, Meg, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia

Meg Jardine, MBBS, PhD

Background

SARS-CoV-2 infection is mediated by angiotensin-converting enzyme 2 receptors. Trials in different settings were initiated to test whether renin-angiotensin-aldosterone system inhibitors (RAASi) improved clinical outcomes in people with COVID-19.

Methods

We performed an individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs) evaluating the effects of RAASi in people with COVID-19. The primary outcome of WHO Clinical Progression scale over 28 days was evaluated using a linear mixed model. All-cause mortality was evaluated with Cox proportional hazards.

Results

Six trials evaluating losartan, telmisartan, and candesartan were included, with sample sizes ranging from 12 to 787. Trials were conducted in the USA, Australia, and India; four were completed as planned, and 5 were placebo controlled. The 1,130 participants had a median age of 50 years and 38% were female. The majority of the cohort was Asian (73%) and Caucasian (16%). The median BMI was 25 kg/m², 29% had hypertension, 21% had diabetes, and 17% had a smoking history. The baseline mean WHO score was 3.6 in the RAASi arm and 3.5 in the control arm. Most participants resolved with a mean WHO score of 1.2 in the RAASi arm and 1.2 in the control arm at day 28, with no significant difference in WHO scale progression (Figure 1, p=0.29). RAASi did not affect overall mortality (26 deaths, event rate 0.04 and 18 deaths, event rate 0.03 in the RAASi and control arms respectively: HR 1.42 [0.77-2.64], p=0.261).

Conclusion

This IPD meta-analysis presents the largest randomized report of the effects of commencing RAASi for acute COVID-19. There is no evidence supporting a benefit for RAASi in COVID-19 patients.