Drugs and the renin-angiotensin system in covid-19
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1313 (Published 02 April 2020) Cite this as: BMJ 2020;369:m1313Read our latest coverage of the coronavirus outbreak
- Jeffrey K Aronson, clinical pharmacologist1,
- Robin E Ferner, honorary professor of clinical pharmacology2
- 1Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- 2Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- Correspondence to: jeffrey.aronson{at}phc.ox.ac.uk
Covid-19, which is caused by the single stranded RNA coronavirus SARS-CoV-2, poses therapeutic dilemmas. Some suggestions for drug treatment seem problematic.1 They include various antiviral drugs, some of which have primary targets that are DNA viruses not RNA; immunomodulatory drugs, which may suppress potentially protective acute inflammatory responses and do not specifically target the virus; the antimalarial drugs chloroquine and hydroxychloroquine, which have some antiviral activity in vitro but no evidence of clinical benefit in human viral infections and also have many adverse effects; and corticosteroids, which may be harmful when used to treat infection with the related virus SARS-CoV-1.2
Important questions have also been raised about the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Do they have a role in treating covid-19? Should people currently taking them continue doing so, and should they stop if they become infected?
No trial evidence is yet available on the effects of ACE inhibitors or ARBs in treating covid-19. But for people already taking these drugs the European Society of Cardiology recommends “that …