Legemiddelverket har tidligere rådet pasienter som behandles med ACE-hemmere og angiotensin-II-reseptorblokkere (ARB-er, også kalt sartaner) mot høyt blodtrykk, hjertesykdom eller nyresykdom til å fortsette sin behandling, selv om det var uklart om disse legemidlene kunne påvirke forløpet av covid-19. Nå bekrefter flere nye studier at disse legemidlene trygt kan brukes.
Nye observasjonsstudier av ACE-hemmere og angiotensinreseptor-II-blokkere viser at:
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disse legemidlene ikke har innvirkning på faren for å få SARS-CoV-2-infeksjon
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det ikke er negativ innvirkning på sykdomsutfallet hos pasienter med covid-19 som samtidig behandles med ACE-hemmere eller ARBer
De nye studiene forsterker rådet om at pasienter bør fortsette å bruke ACE-hemmere eller ARBer slik de er forskrevet av legen. Pasienter som har spørsmål knyttet til blodtrykksbehandlingen sin, bør kontakte legen.
Ingen negativ innvirkning
I mars og april 2020 ble det reist spørsmål om disse legemidlene kunne ha negativ innvirkning hos pasienter med covid-19. Som en del av den kontinuerlige overvåkingen av sikkerheten av legemidler, ble 19 nylig publiserte studier* om dette tema gjennomgått. Studieresultatene gir ikke klinisk evidens for en slik negativ effekt hos pasienter med covid-19.
Legemiddelmyndighetene i Europa overvåker kontinuerlig nye data om sikkerheten av legemidler som brukes under covid-19-pandemien, og gir råd om trygg bruk av legemidler.
Referanser:
1. Bean D, Kraljevic Z, Searle T et al. Treatment with ACE-inhibitors is associated with less severe SARS-Covid-19 infection in a multi-site UK acute Hospital Trust. doi: 10.13140/RG.2.2.34883.14889/1.
2. de Abajo F, Rodríguez-Martín S, Lerma V et al. Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. doi: 10.1016/S0140-6736(20)31030-8.
3. Gao C, Cai Y, Zhang K et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. doi: 10.1093/eurheartj/ehaa433.
4. Gnavi R, Demaria M, Picariello, R et al. Therapy with agents acting on the renin-angiotensin system and risk of SARS-CoV-2 infection. doi: 10.1093/cid/ciaa634.
5. Guo T, Fan Y, Chen M et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). doi: 10.1001/jamacardio.2020.1017.
6. Jung S-Y, Choi JC, You S-H et al. Association of renin-angiotensin-aldosterone system inhibitors with COVID-19-related outcomes in Korea: a nationwide population-based cohort study. doi: 10.1093/cid/ciaa624/5842160.
7. Li J, Wang X, Chen J et al. Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China. doi: 10.1001/jamacardio.2020.1624.
8. Mancia G, Rea F, Ludergnani M et al. Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19. doi: 10.1056/NEJMoa2006923.
9. Mehra MR, Desai SS, Kuy S, et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. doi: 10.1056/NEJMoa2007621. The publication of this study was subsequently retracted by the authors. doi: 10.1056/NEJMc2021225. The retraction has no impact on this public statement as the study did not influence the conclusions.
10. Mehta N, Kalra A, Nowacki AS et al. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). doi: 10.1001/jamacardio.2020.1855.
11. Meng, J, Xiao G, Zhang J et al. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. doi: 10.1080/22221751.2020.1746200.
12. Rentsch CT, Kidwai-Khan F, Tate, JP et al. Covid-19 Testing, Hospital Admission, and Intensive Care Among 2,026,227 United States Veterans Aged 54-75 Years. doi: 10.1101/2020.04.09.20059964.
13. Reynolds HR, Adhikari S, Pulgarin C et al. Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19. doi: 10.1056/NEJMoa2008975.
14. Richardson S, Hirsch JS, Narasimhan M et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. doi: 10.1001/jama.2020.6775.
15. Rossi GP, Marino M, Formisano D et al. Characteristics and outcomes of a cohort of SARS-CoV-2 patients in the province of Reggio Emilia, Italy. doi: 10.1101/2020.04.13.20063545.
16. Tedeschi S, Giannella M, Bartoletti M et al. Clinical impact of renin-angiotensin system inhibitors on in-hospital mortality of patients with hypertension hospitalized for COVID-19. doi: 10.1093/cid/ciaa492.
17. Yang G, Tan Z, Zhou L et al. Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors Usage is Associated with Improved Inflammatory Status and Clinical Outcomes in COVID-19 Patients With Hypertension. doi: 10.1101/2020.03.31.20038935.
18. Zeng Z, Sha T, Zhang Y, et al. Hypertension in patients hospitalized with COVID-19 in Wuhan, China: a single-center retrospective observational study. doi: 10.1101/2020.04.06.20054825.
19. Zhang P, Zhu L, Cai J et al. Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19. doi: 10.1161/CIRCRESAHA.120.317134.
20. EMA: Latest data support continued use of ACE inhibitors and ARB medicines during COVID-19 pandemic