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Published in: Inflammopharmacology 6/2020

01-12-2020 | Severe Acute Respiratory Syndrome Coronavirus | Short Communication

ACEIs, ARBs, ibuprofen originally linked to COVID-19: the other side of the mirror

Author: Mina T. Kelleni

Published in: Inflammopharmacology | Issue 6/2020

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Abstract

During the COVID-19 pandemic, a correspondence, published at the Lancet Respiratory Medicine, that linked angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and ibuprofen to a higher risk of SARS CoV-2 infection and complications, has influenced, when adopted by official health authorities, the practical management of COVID-19 with regard to non-steroidal anti-inflammatory drugs that were avoided in all COVID-19 management protocols all over the world. This manuscript discusses, from a pharmacological point of view, the points of weakness in the mentioned correspondence and it also lists some important contradictory review articles as well as clinical results that refuted its claims. The author chose to argue against each claim represented in the mentioned correspondence to confirm that ACEIs, ARBs and NSAIDs including ibuprofen should not be considered hazardous to be administered for COVID-19 patients and to warn against any future adoption of such unproved claims.
Literature
go back to reference Banu N, Panikar SS, Leal LR, Leal AR (2020) Protective role of ACE2 and its downregulation in SARS-CoV-2 infection leading to macrophage activation syndrome: therapeutic implications. Life Sci 256:117905CrossRef Banu N, Panikar SS, Leal LR, Leal AR (2020) Protective role of ACE2 and its downregulation in SARS-CoV-2 infection leading to macrophage activation syndrome: therapeutic implications. Life Sci 256:117905CrossRef
go back to reference Bean D, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, Roguski L, Noor K, Shek A, Gallagher K, Zakeri R, Shah A, Teo J, Dobson RJB (2020) Treatment with ACE-inhibitors is associated with less severe disease with SARS-COVID-19 infection in a multi-site UK acute Hospital Trust. medRxiv: 2020.2004.2007.20056788 Bean D, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, Roguski L, Noor K, Shek A, Gallagher K, Zakeri R, Shah A, Teo J, Dobson RJB (2020) Treatment with ACE-inhibitors is associated with less severe disease with SARS-COVID-19 infection in a multi-site UK acute Hospital Trust. medRxiv: 2020.2004.2007.20056788
go back to reference Brown JD (2020) Antihypertensive drugs and risk of COVID-19? The Lancet Respir Med 8(5):e28. Brown JD (2020) Antihypertensive drugs and risk of COVID-19? The Lancet Respir Med 8(5):e28.
go back to reference Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW (2020) Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi 48:E008 Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW (2020) Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi 48:E008
go back to reference Deng SQ, Peng HJ (2020) Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China. J Clin Med 9(2) Deng SQ, Peng HJ (2020) Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China. J Clin Med 9(2)
go back to reference Devaux CA, Rolain J-M, Raoult D (2020) ACE2 receptor polymorphism: susceptibility to SARS-CoV-2, hypertension, multi-organ failure, and COVID-19 disease outcome. J Microbiol Immunol Infect 53(3):425–435CrossRef Devaux CA, Rolain J-M, Raoult D (2020) ACE2 receptor polymorphism: susceptibility to SARS-CoV-2, hypertension, multi-organ failure, and COVID-19 disease outcome. J Microbiol Immunol Infect 53(3):425–435CrossRef
go back to reference Fang L, Karakiulakis G, Roth M (2013) Antihypertensive drugs and risk of COVID-19? Authors' reply. Lancet Respir Med 8(5):e32–e33CrossRef Fang L, Karakiulakis G, Roth M (2013) Antihypertensive drugs and risk of COVID-19? Authors' reply. Lancet Respir Med 8(5):e32–e33CrossRef
go back to reference Fang L, Karakiulakis G, Roth M (2020) Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 8(4):e21CrossRef Fang L, Karakiulakis G, Roth M (2020) Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 8(4):e21CrossRef
go back to reference Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C, Kragholm K, Schou M, Phelps M, Gislason GH, Gerds TA, Torp-Pedersen C, Køber L (2020) Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality. JAMA 324(2):168–177CrossRef Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C, Kragholm K, Schou M, Phelps M, Gislason GH, Gerds TA, Torp-Pedersen C, Køber L (2020) Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality. JAMA 324(2):168–177CrossRef
go back to reference Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche,A Muller MA, Drosten C, Pohlmann S (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche,A Muller MA, Drosten C, Pohlmann S (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell
go back to reference Kelleni M (2018) Drug induced malignancy: a focus on pioglitazone. Pharm Pharmacol Int J 6(4):297–299 Kelleni M (2018) Drug induced malignancy: a focus on pioglitazone. Pharm Pharmacol Int J 6(4):297–299
go back to reference Koitka A, Cooper ME, Thomas MC, Tikellis C (2008) Angiotensin converting enzyme 2 in the kidney. Clin Exp Pharmacol Physiol 35(4):420–425CrossRef Koitka A, Cooper ME, Thomas MC, Tikellis C (2008) Angiotensin converting enzyme 2 in the kidney. Clin Exp Pharmacol Physiol 35(4):420–425CrossRef
go back to reference Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, Yang P, Zhang Y, Deng W, Bao L, Zhang B, Liu G, Wang Z, Chappell M, Liu Y, Zheng D, Leibbrandt A, Wada T, Slutsky AS, Liu D, Qin C, Jiang C, Penninger JM (2005) A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus–induced lung injury. Nat Med 11(8):875–879CrossRef Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, Yang P, Zhang Y, Deng W, Bao L, Zhang B, Liu G, Wang Z, Chappell M, Liu Y, Zheng D, Leibbrandt A, Wada T, Slutsky AS, Liu D, Qin C, Jiang C, Penninger JM (2005) A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus–induced lung injury. Nat Med 11(8):875–879CrossRef
go back to reference Li XC, Zhang J, Zhuo JL (2017) The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res 125(Pt A):21–38CrossRef Li XC, Zhang J, Zhuo JL (2017) The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res 125(Pt A):21–38CrossRef
go back to reference Moore N, Carleton B, Blin P, Bosco-Levy P, Droz C (2020) Does ibuprofen worsen COVID-19? Drug Saf 43(7):611–614CrossRef Moore N, Carleton B, Blin P, Bosco-Levy P, Droz C (2020) Does ibuprofen worsen COVID-19? Drug Saf 43(7):611–614CrossRef
go back to reference Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, Butany J (2009) SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 39(7):618–625CrossRef Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, Butany J (2009) SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 39(7):618–625CrossRef
go back to reference Qiao W, Wang C, Chen B, Zhang F, Liu Y, Lu Q, Guo H, Yan C, Sun H, Hu G, Yin X (2015) Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats. Cardiology 131(2):97–106CrossRef Qiao W, Wang C, Chen B, Zhang F, Liu Y, Lu Q, Guo H, Yan C, Sun H, Hu G, Yin X (2015) Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats. Cardiology 131(2):97–106CrossRef
go back to reference Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I (2020) Ibuprofen use and clinical outcomes in COVID-19 patients. Clin Microbiol Infect 26(9):1259.e5–e7CrossRef Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I (2020) Ibuprofen use and clinical outcomes in COVID-19 patients. Clin Microbiol Infect 26(9):1259.e5–e7CrossRef
go back to reference Smart L, Fawkes N, Goggin P, Pennick G, Rainsford KD, Charlesworth B, Shah N (2020) A narrative review of the potential pharmacological influence and safety of ibuprofen on coronavirus disease 19 (COVID-19), ACE2, and the immune system: a dichotomy of expectation and reality. Inflammopharmacology Smart L, Fawkes N, Goggin P, Pennick G, Rainsford KD, Charlesworth B, Shah N (2020) A narrative review of the potential pharmacological influence and safety of ibuprofen on coronavirus disease 19 (COVID-19), ACE2, and the immune system: a dichotomy of expectation and reality. Inflammopharmacology
go back to reference Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD (2020) Renin–angiotensin–aldosterone system inhibitors in patients with COVID-19. N Engl J Med 382(17):1653–1659CrossRef Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD (2020) Renin–angiotensin–aldosterone system inhibitors in patients with COVID-19. N Engl J Med 382(17):1653–1659CrossRef
go back to reference Wakahara S, Konoshita T, Mizuno S, Motomura M, Aoyama C, Makino Y, Kato N, Koni I, Miyamori I (2007) Synergistic expression of angiotensin-converting enzyme (ACE) and ACE2 in human renal tissue and confounding effects of hypertension on the ACE to ACE2 ratio. Endocrinology 148(5):2453–2457CrossRef Wakahara S, Konoshita T, Mizuno S, Motomura M, Aoyama C, Makino Y, Kato N, Koni I, Miyamori I (2007) Synergistic expression of angiotensin-converting enzyme (ACE) and ACE2 in human renal tissue and confounding effects of hypertension on the ACE to ACE2 ratio. Endocrinology 148(5):2453–2457CrossRef
go back to reference Wan Y, Shang J, Graham R, Baric RS, Li F (2020) Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. J Virol JVI.00127-00120 Wan Y, Shang J, Graham R, Baric RS, Li F (2020) Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. J Virol JVI.00127-00120
go back to reference Wang JJ, Edin ML, Zeldin DC, Li C, Wang DW, Chen C (2020) Good or bad: application of RAAS inhibitors in COVID-19 patients with cardiovascular comorbidities. Pharmacol Ther 215:107628CrossRef Wang JJ, Edin ML, Zeldin DC, Li C, Wang DW, Chen C (2020) Good or bad: application of RAAS inhibitors in COVID-19 patients with cardiovascular comorbidities. Pharmacol Ther 215:107628CrossRef
go back to reference Wong DW, Oudit GY, Reich H, Kassiri Z, Zhou J, Liu QC, Backx PH, Penninger JM, Herzenberg AM, Scholey JW (2007) Loss of angiotensin-converting enzyme-2 (Ace2) accelerates diabetic kidney injury. Am J Pathol 171(2):438–451CrossRef Wong DW, Oudit GY, Reich H, Kassiri Z, Zhou J, Liu QC, Backx PH, Penninger JM, Herzenberg AM, Scholey JW (2007) Loss of angiotensin-converting enzyme-2 (Ace2) accelerates diabetic kidney injury. Am J Pathol 171(2):438–451CrossRef
go back to reference Zhang JJ, Dong D, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD (2020) Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 75:1730–1741CrossRef Zhang JJ, Dong D, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD (2020) Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 75:1730–1741CrossRef
go back to reference Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, Si H-R, Zhu Y, Li B, Huang C-L, Chen H-D, Chen J, Luo Y, Guo H, Jiang R-D, Liu M-Q, Chen Y, Shen X-R, Wang X, Zheng X-S, Zhao K, Chen Q-J, Deng F, Liu L-L, Yan B, Zhan F-X, Wang Y-Y, Xiao G-F, Shi Z-L (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579(7798):270–273CrossRef Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, Si H-R, Zhu Y, Li B, Huang C-L, Chen H-D, Chen J, Luo Y, Guo H, Jiang R-D, Liu M-Q, Chen Y, Shen X-R, Wang X, Zheng X-S, Zhao K, Chen Q-J, Deng F, Liu L-L, Yan B, Zhan F-X, Wang Y-Y, Xiao G-F, Shi Z-L (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579(7798):270–273CrossRef
Metadata
Title
ACEIs, ARBs, ibuprofen originally linked to COVID-19: the other side of the mirror
Author
Mina T. Kelleni
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Inflammopharmacology / Issue 6/2020
Print ISSN: 0925-4692
Electronic ISSN: 1568-5608
DOI
https://doi.org/10.1007/s10787-020-00755-x

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