One of the priority questions that we’ve heard from various stakeholders, including the FDA and EMA, is to understand implications of the ACE-2 pathway, which can serve as an entry point for COVID-19 and is also upregulated by ACE inhibitors and Angiotensin Receptor Blockers (two commonly used classes of hypertensive treatments).
ACC/AHA issued the following statement last week: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19
But nonetheless, some clinicians and patients are considering stopping ACE inhibitor therapy due to the posited effect.
In our OHDSI collaborative efforts, we will design and execute studies to produce real-world evidence about the comparative effects of ACE inhibitors and ARBs vs. other antihypertensives for incidence of viral disease and risk of viral complications. @SCYou, @msuchard, @hripcsa and others have already made great progress toward offering a series of study designs to address this, which can be be applied to past viral models (e.g. influenza) and then applied to current and future Covid-exposed patients. But to do so, we need to have proper context around what is known biologically about this potential association, and what (if any) data exists to support or refute an association.
@conovermitch has offered to lead this review and evidence synthesis effort. If others want to join him, please use this Forum thread to get started and let’s see how far we can get by end of Wednesday. Wherever we are by then can serve as the input to the Study-a-thon workstream on this topic.