1. Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical Trial
- Author
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Huang, Daniel Q, Ajmera, Veeral, Tomaszewski, Christian, LaFree, Andrew, Bettencourt, Ricki, Thompson, Wesley K, Smith, Davey M, Malhotra, Atul, Mehta, Ravindra L, Tolia, Vaishal, Yin, Jeffrey, Insel, Paul A, Leachman, Stone, Jung, Jinho, Collier, Summer, Richards, Lisa, Woods, Kristin, Amangurbanova, Maral, Bhatt, Archana, Zhang, Xinlian, Penciu, Oana M, Zarich, Stuart, Retta, Tamrat, Harkins, Michelle S, Teixeira, J Pedro, Chinnock, Brian, Utay, Netanya S, Lake, Jordan E, and Loomba, Rohit
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Trials and Supportive Activities ,Clinical Research ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Good Health and Well Being ,Humans ,Female ,Male ,COVID-19 ,Ramipril ,SARS-CoV-2 ,Retrospective Studies ,Prospective Studies ,Angiotensin-Converting Enzyme Inhibitors ,Double-Blind Method ,Treatment Outcome ,Coronavirus ,Therapy ,Pharmacology and Pharmaceutical Sciences ,General Clinical Medicine ,Clinical sciences ,Pharmacology and pharmaceutical sciences - Abstract
IntroductionRetrospective studies report that angiotensin-converting enzyme inhibitors (ACEIs) may reduce the severity of COVID-19, but prospective data on de novo treatment with ACEIs are limited. The RAMIC trial was a randomized, multicenter, placebo-controlled, double-blind, allocation-concealed clinical trial to examine the efficacy of de novo ramipril versus placebo for the treatment of COVID-19.MethodsEligible participants were aged 18 years and older with a confirmed diagnosis of SARS-CoV-2 infection, recruited from urgent care clinics, emergency departments, and hospital inpatient wards at eight sites in the USA. Participants were randomly assigned to daily ramipril 2.5 mg or placebo orally in a 2:1 ratio, using permuted block randomization. Analyses were conducted on an intention-to-treat basis. The primary outcome was a composite of mortality, intensive care unit (ICU) admission, or invasive mechanical ventilation by day 14.ResultsBetween 27 May 2020 and 19 April 2021, a total of 114 participants (51% female) were randomized to ramipril (n = 79) or placebo (n = 35). The overall mean (± SD) age and BMI were 45 (± 15) years and 33 (± 8) kg/m2. Two participants in the ramipril group required ICU admission and one died, compared with none in the placebo group. There were no significant differences between ramipril and placebo in the primary endpoint (ICU admission, mechanical ventilation, or death) (3% versus 0%, p = 1.00) or adverse events (27% versus 29%, p = 0.82). The study was terminated early because of a low event rate and subsequent Emergency Use Authorization of therapies for COVID-19.ConclusionDe novo ramipril was not different compared with placebo in improving or worsening clinical outcomes from COVID-19 but appeared safe in non-critically ill patients with COVID-19.Trial registrationClinicaltrials.gov NCT04366050.
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- 2023