Thread by @hswapnil, Up next at #ESCCongress is the BRACE-CORONA trial from Brazil on continuing [...]

Swapnil Hiremath, MD, MPH

hswapnil

Up next at #ESCCongress is the BRACE-CORONA trial from Brazil on continuing or stopping ACE/ARBs in COVID-19
https://clinicaltrials.gov/ct2/show/NCT04364893

1/

Angiotensin Receptor Blockers and Angiotensin-converting Enzyme Inhibitors and Adverse Outcomes in...

Angiotensin Receptor Blockers and Angiotensin-converting Enzyme Inhibitors and Adverse Outcomes in Patients With COVID19 - Full Text View.

https://clinicaltrials.gov/ct2/show/NCT04364893

why does it matter?

see the #NephJC background on the topic here - with the science and the evidence so far

http://www.nephjc.com/news/covidace2

#ESCCongress

2/

Should ACE-inhibitors and ARBs be stopped with COVID-19? — NephJC

ACE2, coronavirus, COVID19, SARS, hypertension, COVID-19, RAS, renin-angiotensin system

http://www.nephjc.com/news/covidace2

this is just the first of many trials ongoing to report

see summary here http://www.nephjc.com/news/covidace2 collated by @Ricky_Turgeon & @jordy_bc

#ESCCongress

and it begins

My bet: negative trial

#ESCCongress #COVIDACE2

He calls it rennin

Is that a cardiologist out there?

#ESCCongress

trial design
excluded Entresto-users
also those on 3 or more antiHT drugs. Hmm

Good primary outcome
#ESCCongress

Brazil had it bad - but allowed them to recruit faster

#ESCCongress

figure 1

seems reasonable

would be curious about that 1 site with GCP violations

#ESCCongress

and table 1
~ 50% obese
all HT
very few CKD

#ESCCongress #BRACECORONA

disease severeity and medications at baseline

seems OK

#ESCCongress #BRACECORONA

primary outcome

called it

#ESCCongress #BRACECORONA

No difference in all cause mortality or clinical status at 30 days

#ESCCongress #BRACECorona

since we - the #NephJC #Covidace2 workgroup lead by @Nephro_Sparks had gone on out a limb sorta to advice this back in March http://www.nephjc.com/news/covidace2 #ESCCongress

Most societies also did of course, see table collated by @Jordy_bc

Great to see that sensible thinking in the scientific way turns out to be correct unlike the speculation (in BMJ, Lancet, JH)

#ESCCongress

Should these ongoing trials go on?

These trial interventions are simila to #BRACECORONA. But we don’t see any signal of harm so far. I would argue we need replication and ext validation, so they should go on #ESCCongress

And these trials are different: starting an ARB! They should happen of course - though would nicer to have one or two large RCT than many small ones of course
#ESCCongress

Plus these which will be starting soon or perhaps have already started by now

These trial tables collated by @Ricky_Turgeon & @jordy_bc
All this and more at the #NephJC #COVIDACE2 page http://www.nephjc.com/news/covidace2

#ESCCongress

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