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c19early.org COVID-19 treatment researchRamiprilRamipril (more..)
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Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Huang et al., Advances in Therapy, doi:10.1007/s12325-023-02618-7, Aug 2023
https://c19early.org/huang18.html
Mortality -144% improvement lower risk ← → higher risk Ventilation -289% ICU admission -289% Discharge -144% Ramipril  Huang et al.  LATE TREATMENT RCT Is late treatment with ramipril beneficial for COVID-19? Double-blind RCT 114 patients in the USA Trial underpowered to detect differences c19early.org Huang et al., Advances in Therapy, Aug 2023 0 0.5 1 1.5 2+ RR
RCT 114 non-critically ill COVID-19 patients in the USA showing no significant differences with ramipril treatment.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
risk of death, 144.3% higher, RR 2.44, p = 1.00, treatment 1 of 79 (1.3%), control 0 of 35 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), day 14.
risk of mechanical ventilation, 288.6% higher, RR 3.89, p = 1.00, treatment 2 of 79 (2.5%), control 0 of 35 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), day 14.
risk of ICU admission, 288.6% higher, RR 3.89, p = 1.00, treatment 2 of 79 (2.5%), control 0 of 35 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), day 14.
risk of no hospital discharge, 144.3% higher, RR 2.44, p = 1.00, treatment 1 of 79 (1.3%), control 0 of 35 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), day 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Huang et al., 24 Aug 2023, Double Blind Randomized Controlled Trial, placebo-controlled, USA, peer-reviewed, 29 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: HHS Public Access Author manuscript Author Manuscript Adv Ther. Author manuscript; available in PMC 2024 May 01. Published in final edited form as: Adv Ther. 2023 November ; 40(11): 4805–4816. doi:10.1007/s12325-023-02618-7. Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical Trial Daniel Q. Huang, NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA Author Manuscript Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore Veeral Ajmera, NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA Author Manuscript Christian Tomaszewski, Department of Emergency Medicine, University of California, San Diego and the El Centro Regional, Medical Center, San Diego, CA, USA Andrew LaFree, Department of Emergency Medicine, University of California, San Diego and the El Centro Regional, Medical Center, San Diego, CA, USA Ricki Bettencourt, NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA Wesley K. Thompson, Author Manuscript roloomba@ucsd.edu . Author Contributions. Study design: Rohit Loomba, Veeral Ajmera, Daniel Huang. Data acquisition: Veeral Ajmera, Daniel Huang, Christian Tomaszewski, Andrew LaFree, Jinho Jung, Maral Amangurbanova, Michelle S. Harkins, Wesley K Thompson, Davey M Smith, Atul Malhotra, Ravindra L Mehta, Vaishal Tolia, Jeffery Yin, Paul A Insel, Stone Leachman, Summer Collier, Lissa Richards, Kristin Woods, Archana Bhatt, Xinlian Zhang, Oana M Penciu, Stuart Zarich, Tamrat Retta, J Pedro Teixeira, Brian Chinnock, Netanya S Utay, Jordan Lake, Rohit Loomba. Data analysis: Ricki Bettencourt, Daniel Huang, Rohit Loomba. Data interpretation and review/revision of the manuscript: All authors. Study concept and study supervision: Rohit Loomba. All authors approved the final draft of the manuscript as well as the authorship list. Daniel Q. Huang and Veeral Ajmera share co-first authorship. Compliance with Ethics Guidelines. This study was approved by the institutional review board for all sites (Advarra IRB approved Apr 2020, A Randomized, Double-blind, Placebo Controlled Trial to Evaluate the Efficacy of Ramipril to Prevent ICU Admission, Mechanical Ventilation or Death in Persons with COVID-19 [Pro00043364]). Consent was obtained from each patient, and was received either in-person, or by videoconference or telephone, which occurred in the presence of a co-signing witness. All authors agree with the manuscript and consent for its publication. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/ s12325-023-02618-7. Huang et al. Page 2 Author Manuscript Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA Davey M. Smith, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA Veteran Affairs Medical Center, San Diego, CA, USA Atul Malhotra, Division of Pulmonary, Critical Care and Sleep..
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Late treatment
is less effective
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