EMA Says Stay on Angiotensin Drugs During COVID-19 Pandemic

Patrice Wendling


March 27, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The European Medicines Agency (EMA) has issued a statement advising that patients continue treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), despite widely circulated reports that the agents could worsen coronavirus disease.

"It is important that patients do not interrupt their treatment with ACE inhibitors or ARBs and there is no need to switch to other medicines," the agency said today. "There is currently no evidence from clinical or epidemiological studies that establishes a link between ACE inhibitors or ARBs and the worsening of COVID-19."

The new guidance is in line with that recently issued by the European Society of Cardiology and three American cardiology societies. The medications are commonly used by patients with hypertension, heart failure, and kidney disease.

Because the coronavirus infects human cells by binding to ACE2 receptors and because these medicines can increase ACE2, it has been suggested that they could increase virus activity. However, the interactions of the virus with the renin-angiotensin-aldosterone system in the body are complex and are not completely understood, the agency notes.

"The speculation that ACE-inhibitors or ARBs treatment can make infections worse in the context of COVID-19 is not supported by clinical evidence," the EMA reiterated.

Although not noted in the statement, other reports have suggested that ACE inhibitors and ARBs may reduce the risk for or severity of viral pneumonia in patients with COVID-19 infection, or may actually have potential as treatments.

The EMA is collaborating with stakeholders to generate further evidence in epidemiologic studies on the effects of ACE inhibitors and ARBs in people with COVID-19.

In light of circulating reports questioning whether nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, also could worsen COVID-19, the agency also recently issued guidance on the use of NSAIDs during the pandemic.

The EMA highlighted the need for future epidemiologic studies and stated, "There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19."

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