Discontinuation of Renin-Angiotensin System Inhibitors During the Early Stage of the COVID-19 Pandemic.
Discontinuation of Renin-Angiotensin System Inhibitors During the Early Stage of the COVID-19 Pandemic.
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在 COVID-19 大流行的早期阶段停用肾素-血管紧张素系统抑制剂。
DOI：
10.1093/ajh/hpad027
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发表时间：
2023
影响因子：
3.2
通讯作者：
Kronish,Ian
中科院分区：
文献类型：
--
作者：
Muntner,Paul;Foti,Kathryn;Wang,Zhixin;Alanaeme,ChibuikeJ;Choi,Eunhee;Bress,AdamP;Shimbo,Daichi;Kronish,Ian
背景2020年3月和4月，医学会发表声明，建议继续使用肾素-血管紧张素系统（RAS）抑制剂，尽管理论上担心这些药物可能会增加COVID-19的严重程度。确定患者在COVID-19大流行期间是否停用RAS抑制剂可以为应对未来的公共卫生突发事件提供信息。MethodsWe分析了Marketscan数据库中美国成年人健康保险的索赔数据。我们确定了从2019年3月至2020年2月期间填充RAS抑制剂且持续性的患者，定义为没有≥30天的药物可用间隔，以及高依从性，定义为≥80%的天数有药物可用。在这些患者中，我们估计了停用RAS抑制剂的比例（即，在2020年3月至8月期间连续≥30天未使用RAS抑制剂）。为了进行比较，我们估计了2018年3月至2019年2月期间持续高依从性并在2019年3月至8月期间停用RAS抑制剂的患者比例。结果在2019年3月至2020年2月期间持续并依从RAS抑制剂的816，380名成人中，10.8%在2020年3月至8月期间停用该药物。在2018年3月至2019年2月期间持续并坚持使用RAS抑制剂的822，873名成人中，11.7%在2019年3月至8月期间停用了这种药物。与2019年相比，2020年停用RAS抑制剂的多变量校正相对风险为0.94（95%CI 0.93-0.95）。结论在COVID-19大流行的早期阶段，没有证据表明RAS抑制剂停用增加。
BackgroundIn March and April 2020, medical societies published statements recommending continued use of renin–angiotensin system (RAS) inhibitors despite theoretical concerns that these medications could increase COVID-19 severity. Determining if patients discontinued RAS inhibitors during the COVID-19 pandemic could inform responses to future public health emergencies.MethodsWe analyzed claims data from US adults with health insurance in the Marketscan database. We identified patients who filled a RAS inhibitor and were persistent, defined by not having a ≥30-day gap without medication available, and high adherence, defined by having medication available on ≥80% of days, from March 2019 to February 2020. Among these patients, we estimated the proportion who discontinued their RAS inhibitor (i.e., had ≥30 consecutive days without a RAS inhibitor available to take) between March and August 2020. For comparison, we estimated the proportion of patients that discontinued a RAS inhibitor between March and August 2019 after being persistent with high adherence from March 2018 to February 2019.ResultsAmong 816,380 adults who were persistent and adherent to a RAS inhibitor from March 2019 to February 2020, 10.8% discontinued this medication between March and August 2020. Among 822,873 adults who were persistent and adherent to a RAS inhibitor from March 2018 to February 2019, 11.7% discontinued this medication between March and August 2019. The multivariable-adjusted relative risk for RAS inhibitor discontinuation in 2020 vs. 2019 was 0.94 (95% CI 0.93–0.95).ConclusionsThere was no evidence of an increase in RAS inhibitor discontinuation during the early stage of the COVID-19 pandemic.