CLARITY
Trial question
What is the role of ARBs in patients with COVID-19 infection?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 787
787 patients (282 female, 505 male)
Inclusion criteria: adult patients admitted to the hospital for the management of COVID-19
Key exclusion criteria: previous treatment with a RAS blockade; hyperkalemia or unrecorded serum potassium; low eGFR; or unrecorded kidney function
Interventions
N=393 ARB (predominantly oral telmisartan at a starting dose of 40 mg/day for 28 days)
N=394 placebo (matching placebo for 28 days)
Primary outcome
World Health Organization Scale score at day 14
1
1
1.0 point
0.8 point
0.5 point
0.3 point
0.0 point
Angiotensin receptor
blocker
Placebo
Significant
increase ▲
Significant increase in WHO Scale score at day 14 (1 point vs. 1 point; OR 1.51, 95% CI 1.02 to 2.23)
Secondary outcomes
No significant difference in death at day 28 (2.5% vs. 1.5%; OR 1.74, 95% CI 0.62 to 5.25)
No significant difference in respiratory failure (6.6% vs. 5.1%; HR 1.32, 95% CI 0.74 to 2.43)
Safety outcomes
No significant differences in hyperkalemia, hypotension, AKI.
Conclusion
In adult patients admitted to the hospital for the management of COVID-19, ARB was not superior to placebo with respect to WHO Scale score at day 14.
Reference
Meg J Jardine, Sradha S Kotwal, Abhinav Bassi et al. Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trial. BMJ. 2022 Nov 16;379:e072175.
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