New Delhi: Can angiotensin receptor blockers, which disrupt the renin-angiotensin system, help COVID-19 outcomes?
The answer turns out to be “no” according to the effects of the CLARITY trial recently published in the BMJ. The trial, which was conducted on patients at 17 sites in India and Australia, showed that the drug used to treat high blood pressure proved useless. in the treatment of even mild cases of COVID-19.
CLARITY, a Phase 3, pragmatic, adaptive, multicenter, randomized controlled trial promoted through prior knowledge in mice that suggested that modulation of the renin-angiotensin ratio with ARBs might possibly have protective effects in patients with SARS-CoV- two.
As a result, a randomized controlled trial was conducted with 787 patients (778 from India and nine from Australia) with an average age of 49 years who were admitted to hospital from May 2020 to November 2021. Including patients with the most mild illnesses, the researchers aimed to recruit patients at risk of severe covid.
Half of the participants overall received angiotensin receptor blockers or ARBs (drugs widely used to treat high blood pressure and central disease) and the other half (controls) received a placebo for 28 days.
The number one endpoint was Covid-19 disease severity, a World Health Organization clinical progression scale (WHO scale) modified on day 14. Secondary outcomes were WHO scale scores at day 28, mortality, ICU admission and respiratory failure. Analyses were assessed on an ordinal scale in the intention-to-treat population.
A popular dose of the ARB drug, telmisartan (starting dose of 40 mg/d) is only used in India, while the type and dose of ARB are left to the discretion of treating physicians in Australia.
These drugs were selected because they work by regulating the same angiotensin protein that is used through the coronavirus to enter the body, and in the laboratory, they have shown coverage against the severe effects of coronaviruses.
However, after 14 days of treatment, the researchers did not discover any significant difference in disease severity between the two groups. The trial was stopped when a previously specified futility rule was respected.
These effects are expected in clinical practice. The absence of effect reassures the protection of the use of these protective agents in the indicated people, with or without covid-19.
He has significant limitations.
In the randomized controlled trial, researchers were unable to discharge a placebo in Australia, meaning participants and the doctors treating them knew they were taking an active drug. Participants were also treated with a low dose of the drug, so the effect of higher doses is unknown. .
Ref: BMJ 2022;379:e072175
Meghna A Singhania is the founder and editor-in-chief of Medical Dialogues. With a degree in Economics from the University of Delhi and a graduate of the London School of Economics and Political Science, her main interests are fitness economics and the advancement of policies in the country. fitness and medical sector. He is a member of the Association of Health Journalists. She can be reached at editor@medicaldialogues. in. Contact number 011-43720751
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