Article Dans Une Revue Clinical Infectious Diseases Année : 2024

Effects of Losartan on Patients Hospitalized for Acute Coronavirus Disease 2019: A Randomized Controlled Trial

Julien Demiselle
David Sweet
  • Fonction : Auteur
John Boyd
  • Fonction : Auteur
Keith Walley
  • Fonction : Auteur
Greg Haljan
  • Fonction : Auteur
Omar Sharif
  • Fonction : Auteur
Guillaume Geri
Todd C. Lee
  • Fonction : Auteur
Ferhat Meziani
Francois Lamontagne
Daniel Ovakim
  • Fonction : Auteur
Gordon Wood
  • Fonction : Auteur
Alexis Turgeon
  • Fonction : Auteur
Yves Cohen
  • Fonction : Auteur
Eddy Lebas
  • Fonction : Auteur
Marine Goudelin
  • Fonction : Auteur
David Forrest
  • Fonction : Auteur
  • PersonId : 898146
Alastair Teale
  • Fonction : Auteur
Jean-Paul Mira
Robert Fowler
  • Fonction : Auteur
Nick Daneman
  • Fonction : Auteur
Neill K.J. Adhikari
Pierre Leroy
Patrick Rispal
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  • PersonId : 955443
Roxane Courtois
  • Fonction : Auteur
Boris Bienvenu
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  • PersonId : 1045277
Severine Ansart
  • Fonction : Auteur

Résumé

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19. Methods. Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs). Results. The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes. Conclusions. Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.

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hal-04701585 , version 1 (23-01-2026)

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Karen C. Tran, Pierre Asfar, Matthew Cheng, Julien Demiselle, Joel Singer, et al.. Effects of Losartan on Patients Hospitalized for Acute Coronavirus Disease 2019: A Randomized Controlled Trial. Clinical Infectious Diseases, 2024, 79, pp.615-625. ⟨10.1093/cid/ciae306⟩. ⟨hal-04701585⟩
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