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BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m406 (Published 31 January 2020) Cite this as: BMJ 2020;368:m406

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Rapid Response:

Inappropriate ARBs and ACE inhibitors prescription for COVID-2019 infection prevention

Dear Editor,

The notion that angiotensin receptor blockers (ARBs) like Losartan can prevent COVID-2019 infection has started to circulate, and in some cases we also witnessed its prescription for this reason, although no basis of evidence is available to date.

This notion started from a comment by Phadke and Saunik [1], who suggested the use of ARBs like Losartan since it has been demonstrated that SARS-CoV-2 uses angiotensin converting enzyme 2 (ACE2) receptors to enter its host.

In their comment there is an evident mistake, and, as Akamatsu stated in another comment [2], ARBs act on Angiotensin 2 receptors (AT2), which are not the same as ACE receptors. Akamatsu suggests then the possible use of ACE-inhibitors as potentially effective drugs to prevent COVID-2019 infection, although this class of drugs may worsen respiratory symptoms like cough.

But even this statement is incorrect, since the ACE2 receptor, which is different from the ACE receptor and was discovered in the 2000s, is insensitive to classical ACE inhibitors [3].

Therefore, there is no indication, and no pharmacological base, to prescribe or suggest ARBs or ACE inhibitors for COVID-2019 infection.

This practice, besides being useless to prevent COVID-2019 infection, may be harmful, leading to inappropriate drug treatments and risk of adverse events, or may instill dangerous over-confidence against the infection risk.

Therefore, the practice of prescribing ARBs or ACE-inhibitors for the prevention of COVID-2019 infection should be discouraged.

References

1) https://www.bmj.com/content/368/bmj.m406/rr-2

2) https://www.bmj.com/content/368/bmj.m406/rr-7

3) Patel, V. B., Zhong, J. C., Grant, M. B., & Oudit, G. Y. (2016). Role of the ACE2/angiotensin 1–7 axis of the renin–angiotensin system in heart failure. Circulation research, 118(8), 1313-1326

Competing interests: No competing interests

26 February 2020
Davide Donelli
Physician
Michele Antonelli
AUSL-IRCCS Reggio Emilia
P.zza Matteotti 4, Guastalla, Italy