Stopping ACE-inhibitors in COVID-19 (ACEI-COVID-19)

The COVID 19 pandemic currently poses unprecedented challenges to the health care systems of all countries. A large proportion of patients with severe disease progression suffer from pre-existing conditions such as high blood pressure, diabetes mellitus and heart failure, which are often treated with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs). Experimental studies suggest that these drugs is might facilitate the uptake of SARS-CoV2 into the human body. The project will therefore test whether replacing or discontinuing chronic ACEI/ARB therapy attenuates COVID-19. In half of the patients, the existing medication with ACEI/ARB is continued, while in the other half of the patients the treatment is stopped or replaced. Both treatment groups are closely monitored. The groups are selected randomly to ensure the highest level of scientific investigation. Subsequently, the severity of COVID-19 is compared between treatment groups. In order to answer this question as quickly as possible, the project will take place in 40 centres in Austria and Germany, including 208 study participants.

The "Stopping ACE-inhibitors in COVID-19" (ACEI-COVID-19) project aimed to address a critical question during the COVID-19 pandemic: whether discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in patients diagnosed with COVID-19 could influence the disease's progression and outcome. ACEIs and ARBs are widely prescribed medications used to manage conditions like hypertension and heart failure. However, early in the pandemic, there were concerns that these drugs might exacerbate COVID-19 by affecting the body's mechanism to regulate blood pressure and inflammation. Therefore, understanding the impact of these medications on COVID-19 was of utmost importance. To answer this question the ACEI-COVID trial conducted at 35 centers across Austria and Germany was initiated. It was the first European, multicentre study to address this issue. In this clinical trial, patients with a recent symptomatic SARS-CoV-2 infection who were already taking ACEIs or ARBs were divided into two groups: one group continued their medication, while the other group discontinued it. The primary goal was to observe if stopping these medications would lead to a less severe course of COVID-19. ACEI-COVID found that stopping ACEIs or ARBs did not significantly affect the maximum severity of COVID-19. However, there was an indication that patients who discontinued these medications might experience a faster and better recovery. This suggests that while stopping these drugs does not necessarily prevent severe outcomes, it may contribute to a quicker improvement in patients who are older and more vulnerable. Importantly, ACEI-COVID highlighted that decisions regarding the continuation or discontinuation of ACEIs and ARBs should be personalized. Factors such as the patient's overall risk profile, the reason for taking these medications, and the availability of alternative treatments should all be considered. Published in a top-ranking scientific journal, this study garnered significant international attention. The results were included in the official guidelines of the World Health Organization (WHO) on the management of COVID-19 and have so far been cited as a reference in a total of around 100 scientific papers. A follow-up study with the Austrian participants extended these findings. Over a longer period, no significant differences were observed between the groups that continued or discontinued their medication. This long-term observation further supports the notion that the decision to stop or continue ACEIs or ARBs should be individualized rather than generalized. In conclusion, the ACEI-COVID-19 project provided valuable insights into the management of COVID-19 in patients using ACEIs and ARBs. While discontinuing these medications does not significantly impact disease severity, it may benefit recovery speed. These findings have important implications for clinical practice, emphasizing the need for tailored treatment plans based on individual patient needs and circumstances.