Evidence map›Paper›PMID 34126053›Full record

Trial reportThe Lancet. Respiratory medicine2021

Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial.

Axel Bauer, Michael Schreinlechner, Nikolay Sappler, Theresa Dolejsi, Herbert Tilg, Benedikt A Aulinger, Günter Weiss, Rosa Bellmann-Weiler, Christian Adolf, Dominik Wolf and 30 more

Erratum issuedOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Respiratory medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 64 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 8 pooled it
6.0field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 8 syntheses or guidelines pooled it, 103 citations in OpenAlex.

  1. Withdrawal of antihypertensive drugs in older people.The Cochrane database of systematic reviews · 2025
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  9. Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024
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4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

40 authors at 19 institutions in 2 countries.

Axel BauerDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: axel.bauer@i-med.ac.at.
Michael SchreinlechnerDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Nikolay SapplerDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Theresa DolejsiDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Herbert TilgDepartment of Internal Medicine I, Gastroenterology, Hepatology, and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria.
Benedikt A AulingerMedizinische Klinik und Poliklinik II, LMU University Hospital Munich, Munich, Germany.
Günter WeissDepartment of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology and Pneumology, Medical University of Innsbruck, Innsbruck, Austria.
Rosa Bellmann-WeilerDepartment of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology and Pneumology, Medical University of Innsbruck, Innsbruck, Austria.
Christian AdolfMedizinische Klinik und Poliklinik IV, LMU University Hospital Munich, Munich, Germany.
Dominik WolfDepartment of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria.
Markus PirklbauerDepartment of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria.
Ivo GraziadeiDepartment of Internal Medicine, Hospital Hall in Tirol, Hall in Tirol, Austria.
Hannes GänzerDepartment of Internal Medicine, Hospital Schwaz, Schwaz, Austria.
Christian von BaryDepartment of Internal Medicine I, Rotkreuzklinikum Munich, Munich, Germany.
Andreas E MayDepartment of Internal Medicine, Hospital Memmingen, Memmingen, Germany.
Ewald WöllDepartment of Internal Medicine, Hospital Zams, Zams, Austria.
Wolfgang von ScheidtDepartment of Internal Medicine I, University Hospital Augsburg, Augsburg, Germany.
Tienush RassafDepartment of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Duisburg-Essen, Essen, Germany.
Daniel DuerschmiedUniversity Heart Center Freiburg, Department of Cardiology and Angiology I, University of Freiburg, Freiburg, Germany.
Christoph BrennerDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Stefan KääbMedizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.
Bernhard MetzlerDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Michael JoannidisDivision of Intensive Care and Emergency Medicine, Department Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Hans-Ulrich KainDepartment of Internal Medicine, Hospital Mühldorf, Mühldorf, Germany.
Norbert KaiserDepartment of Internal Medicine, Hospital St Johann in Tirol, St Johann in Tirol, Austria.
Robert SchwingerDepartment of Internal Medicine, Hospital Weiden, Weiden, Germany.
Bernhard WitzenbichlerDepartment of Internal Medicine, Hospital Dachau, Dachau, Germany.
Hannes AlberDepartment of Internal Medicine and Cardiology, Klinikum Klagenfurt am Woerthersee, Klagenfurt, Austria.
Florian StraubeDepartment of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen and Schwabing, Munich, Germany.
Niels HartmannDepartment of Internal Medicine I (Cardiology), University Hospital Aachen, Aachen, Germany.
Stephan AchenbachDepartment of Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany.
Michael von Bergwelt-BaildonMedizinische Klinik und Poliklinik III, LMU University Hospital Munich, Munich, Germany.
Lukas von StülpnagelDepartment of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria; Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.
Sebastian SchoenherrDivision of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
Lukas ForerDivision of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
Sabine Embacher-AichhornCompetence Center for Clinical Trials, Medical University of Innsbruck, Innsbruck, Austria.
Ulrich MansmannInstitute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Germany.
Konstantinos D RizasMedizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.
Steffen MassbergMedizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany. Electronic address: steffen.massberg@med.uni-muenchen.de.
ACEI-COVID investigators
Innsbruck Medical University · ATUniversität Innsbruck · ATLudwig-Maximilians-Universität München · DEGerman Centre for Cardiovascular Research · DEHanusch Hospital · ATHelios Amper-Klinikum Dachau · DEKernkraftwerk Gundremmingen · DEKlinikum Klagenfurt · ATKlinikum Weiden · DELMU Klinikum · DEMünchen Klinik Bogenhausen · DERotkreuzklinikum München · DETirol Kliniken · ATUniversitäts-Herzzentrum Freiburg-Bad Krozingen · DEUniversitätsklinikum Aachen · DEUniversitätsklinikum Erlangen · DEUniversity Hospital Augsburg · DEWest German Heart and Vascular Center Essen · DEZimmer Biomet (Germany) · DE

Funding

Austrian Science Fund FWF KLI 900
6 · The paper itself

Abstract

backgroundSARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin-angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE-inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) mitigates the course o\f recent-onset COVID-19.

methodsACEI-COVID was a parallel group, randomised, controlled, open-label trial done at 35 centres in Austria and Germany. Patients aged 18 years and older were enrolled if they presented with recent symptomatic SARS-CoV-2 infection and were chronically treated with ACEIs or ARBs. Patients were randomly assigned 1:1 to discontinuation or continuation of RAS inhibition for 30 days. Primary outcome was the maximum sequential organ failure assessment (SOFA) score within 30 days, where death was scored with the maximum achievable SOFA score. Secondary endpoints were area under the death-adjusted SOFA score (AUC

findingsBetween April 20, 2020, and Jan 20, 2021, 204 patients (median age 75 years [IQR 66-80], 37% females) were randomly assigned to discontinue (n=104) or continue (n=100) RAS inhibition. Within 30 days, eight (8%) of 104 died in the discontinuation group and 12 (12%) of 100 patients died in the continuation group (p=0·42). There was no significant difference in the primary endpoint between the discontinuation and continuation group (median [IQR] maximum SOFA score 0·00 (0·00-2·00) vs 1·00 (0·00-3·00); p=0·12). Discontinuation was associated with a significantly lower AUC

interpretationDiscontinuation of RAS-inhibition in COVID-19 had no significant effect on the maximum severity of COVID-19 but may lead to a faster and better recovery. The decision to continue or discontinue should be made on an individual basis, considering the risk profile, the indication for RAS inhibition, and the availability of alternative therapies and outpatient monitoring options.

fundingAustrian Science Fund and German Center for Cardiovascular Research.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCOVID-19HypertensionRenin-Angiotensin SystemSARS-CoV-2Angiotensin-Converting Enzyme 2Area Under CurveFemaleHumansMaleMiddle AgedOrgan Dysfunction ScoresOutcome and Process Assessment, Health CareRisk AdjustmentSeverity of Illness IndexACE2 protein, humanAngiotensin-Converting Enzyme 2Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor Antagonists

Identifiers

PMID34126053
PMCPMC8195495
OpenAlexW3169034632

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.