The first randomized controlled trial of an ARB for treatment of COVID-19 returned preliminary results showing possible improvements in time to discharge, need for supplementary oxygen and CRP . See "Telmisartan for treatment of Covid-19 patients: an open randomized clinical trial. Preliminary report. " See independent critical appraisal of trial.
List of Angiotensin-receptor blocker (ARB) trials for COVID-19:
Do Angiotensin Receptor Blockers Mitigate Progression to Acute Respiratory Distress Syndrome With SARS-CoV-2 Infection . Intervention : Losartan 12.5mg bid, can be increased based on SBP.
Valsartan for Prevention of Acute Respiratory Distress Syndrome in Hospitalized Patients With SARS-COV-2 (COVID-19) Infection Disease . Intervention : Valsartan titrated based on BP, maximum of 160mg bid.
COVID MED Trial - Comparison Of Therapeutics for Hospitalized Patients Infected With SARS-CoV-2 (COVIDMED) . Intervention : Losartan, 25 mg po QD X 5-14 days "depending on availability."
Study of Open Label Losartan in COVID-19 . Intervention : Losartan 25mg qd, escalated to 50mg od.
Losartan for Patients With COVID-19 Requiring Hospitalization . Intervention : Losartan 50mg od.
Losartan for Patients With COVID-19 Not Requiring Hospitalization . Intervention : Losartan 25mg od.
Telmisartan for Treatment of COVID-19 Patients . Intervention : Telmisartan 80mg bid.
Treatments to Decrease the Risk of Hospitalization or Death in Elderly Outpatients With Symptomatic SARS-CoV-2 Infection (COVID-19) (COVERAGE) . Intervention : Telmisartan 20mg od.
Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY Disease (CLARITY) . Intervention : ARB, dose/medication not specified.
CLARITY 2.0 . Intervention : ARB, dose/medication unknown, plus CCR2-inhibitor, DMX-200.
Chloroquine + Losartan Compared to Chloroquine Alone for the Treatment of COVID-19 Pneumonia . Intervention : Losartan 25mg bid.
Early Treatment With Ivermectin and LosarTAN for Cancer Patients With COVID-19 Infection (TITAN) . Intervention : Losartan 50mg od.
Austrian CoronaVirus Adaptive Clinical Trial (COVID-19) (ACOVACT) . Intervention : Candesartan 4mg od, titrated up based on BP.
Pilot Clinical Trial of the Safety and Efficacy of Telmisartan for the Mitigation of Pulmonary and Cardiac Complications in COVID-19 Patients . Intervention : Telmisartan 40mg od.
Host Response Mediators in Coronavirus (COVID-19) Infection (ARBS CORONA I) . Intervention : observational study of existing ACEi/ARB users.
Host response mediators in Coronavirus (COVID-19) infection - Is there a protective effect of ARBs on outcomes of Coronavirus infection? (ARBs CORONA II) . Intervention : Losartan 25mg, then 24 hours later 50mg, then 24 hours later 100mg.
The McGill RAAS-COVID-19 Randomized Controlled Trial (RAAS-COVID) . Intervention : observational study of existing ACEi/ARB users. Will suspend or hold ACEi/ARB.
Telmisartan in Respiratory Failure Due to COVID-19 (STAR-COVID) . Intervention : Telmisartan 40mg od.
Evaluation of the effects of Losartan in patients with corona virus disease 2019 . Intervention : Losartan 25mg bid.
The COVID-RASi Trial (COVID-19) . Intervention : ACEi or ARB of choice (unspecified).
Losartan and Spironolactone Treatment for ICU Patients With COVID-19 Suffering From ARDS (COVIDANCE) . Intervention : Losartan 50mg od, Spironolactone 25mg od.
Combination Therapies to Reduce Carriage of SARS-Cov-2 and Improve Outcome of COVID-19 in Ivory Coast: a Phase Randomized IIb Trial (INTENSE-COV) . Intervention : Lopinavir/ritonavir + telmisartan. Telmisartan 40mg od for 10 days.
Safety, tolerability, and outcomes of losartan use in patients hospitalized with SARS-CoV-2 infection: A feasibility study . This was a prospective cohort study comparing de novo initiation of losartan in hospitalized hypertensive COVID-19 patients to a retrospective cohort of hospitalized hypertensive COVID-19 patients already on losartan. Intervention : Losartan 25mg od, titrated daily by 25mg until 100mg od.
Results : "In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension...There were suggestions of lung protection with losartan use, including the observation of an improvement in S/F ratio during hospitalization in the prospective cohort, however these findings would need validation through a properly designed randomized clinical trial (RCT)"
Paper : results paper in PLOS ONE .
Other trials of renin-angiotensin modulation for COVID-19:
C21, an AT2R agonist, has shown benefit in animal lung injury models, similar to ARBs. In a recent randomized, placebo-controlled clinical trial , C21 showed promise as COVID-19 treatment. Photo CC-BY Rathinasabapathy, et al .
While not a trial of ARBs as therapy, BRACE CORONA was a randomized controlled trial exploring stopping-versus-continuing ACE inhibitors/ARBs in patients with hypertension. It showed no harm in continuation of ACE inhibitors and ARBs with COVID-19. There was a non-statistically significant hint of a benefit in the ACEi/ARB group but the trial was not powered to detect this.
See also
The first randomized controlled trial of an ARB for treatment of COVID-19 returned preliminary results showing possible improvements in time to discharge, need for supplementary oxygen and CRP . See "Telmisartan for treatment of Covid-19 patients: an open randomized clinical trial. Preliminary report. " See independent critical appraisal of trial.
List of Angiotensin-receptor blocker (ARB) trials for COVID-19:
Do Angiotensin Receptor Blockers Mitigate Progression to Acute Respiratory Distress Syndrome With SARS-CoV-2 Infection . Intervention : Losartan 12.5mg bid, can be increased based on SBP.
Valsartan for Prevention of Acute Respiratory Distress Syndrome in Hospitalized Patients With SARS-COV-2 (COVID-19) Infection Disease . Intervention : Valsartan titrated based on BP, maximum of 160mg bid.
COVID MED Trial - Comparison Of Therapeutics for Hospitalized Patients Infected With SARS-CoV-2 (COVIDMED) . Intervention : Losartan, 25 mg po QD X 5-14 days "depending on availability."
Study of Open Label Losartan in COVID-19 . Intervention : Losartan 25mg qd, escalated to 50mg od.
Losartan for Patients With COVID-19 Requiring Hospitalization . Intervention : Losartan 50mg od.
Losartan for Patients With COVID-19 Not Requiring Hospitalization . Intervention : Losartan 25mg od.
Telmisartan for Treatment of COVID-19 Patients . Intervention : Telmisartan 80mg bid.
Treatments to Decrease the Risk of Hospitalization or Death in Elderly Outpatients With Symptomatic SARS-CoV-2 Infection (COVID-19) (COVERAGE) . Intervention : Telmisartan 20mg od.
Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY Disease (CLARITY) . Intervention : ARB, dose/medication not specified.
CLARITY 2.0 . Intervention : ARB, dose/medication unknown, plus CCR2-inhibitor, DMX-200.
Chloroquine + Losartan Compared to Chloroquine Alone for the Treatment of COVID-19 Pneumonia . Intervention : Losartan 25mg bid.
Early Treatment With Ivermectin and LosarTAN for Cancer Patients With COVID-19 Infection (TITAN) . Intervention : Losartan 50mg od.
Austrian CoronaVirus Adaptive Clinical Trial (COVID-19) (ACOVACT) . Intervention : Candesartan 4mg od, titrated up based on BP.
Pilot Clinical Trial of the Safety and Efficacy of Telmisartan for the Mitigation of Pulmonary and Cardiac Complications in COVID-19 Patients . Intervention : Telmisartan 40mg od.
Host Response Mediators in Coronavirus (COVID-19) Infection (ARBS CORONA I) . Intervention : observational study of existing ACEi/ARB users.
Host response mediators in Coronavirus (COVID-19) infection - Is there a protective effect of ARBs on outcomes of Coronavirus infection? (ARBs CORONA II) . Intervention : Losartan 25mg, then 24 hours later 50mg, then 24 hours later 100mg.
The McGill RAAS-COVID-19 Randomized Controlled Trial (RAAS-COVID) . Intervention : observational study of existing ACEi/ARB users. Will suspend or hold ACEi/ARB.
Telmisartan in Respiratory Failure Due to COVID-19 (STAR-COVID) . Intervention : Telmisartan 40mg od.
Evaluation of the effects of Losartan in patients with corona virus disease 2019 . Intervention : Losartan 25mg bid.
The COVID-RASi Trial (COVID-19) . Intervention : ACEi or ARB of choice (unspecified).
Losartan and Spironolactone Treatment for ICU Patients With COVID-19 Suffering From ARDS (COVIDANCE) . Intervention : Losartan 50mg od, Spironolactone 25mg od.
Combination Therapies to Reduce Carriage of SARS-Cov-2 and Improve Outcome of COVID-19 in Ivory Coast: a Phase Randomized IIb Trial (INTENSE-COV) . Intervention : Lopinavir/ritonavir + telmisartan. Telmisartan 40mg od for 10 days.
Safety, tolerability, and outcomes of losartan use in patients hospitalized with SARS-CoV-2 infection: A feasibility study . This was a prospective cohort study comparing de novo initiation of losartan in hospitalized hypertensive COVID-19 patients to a retrospective cohort of hospitalized hypertensive COVID-19 patients already on losartan. Intervention : Losartan 25mg od, titrated daily by 25mg until 100mg od.
Results : "In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension...There were suggestions of lung protection with losartan use, including the observation of an improvement in S/F ratio during hospitalization in the prospective cohort, however these findings would need validation through a properly designed randomized clinical trial (RCT)"
Paper : results paper in PLOS ONE .
Other trials of renin-angiotensin modulation for COVID-19:
C21, an AT2R agonist, has shown benefit in animal lung injury models, similar to ARBs. In a recent randomized, placebo-controlled clinical trial , C21 showed promise as COVID-19 treatment. Photo CC-BY Rathinasabapathy, et al .
While not a trial of ARBs as therapy, BRACE CORONA was a randomized controlled trial exploring stopping-versus-continuing ACE inhibitors/ARBs in patients with hypertension. It showed no harm in continuation of ACE inhibitors and ARBs with COVID-19. There was a non-statistically significant hint of a benefit in the ACEi/ARB group but the trial was not powered to detect this.
See also