Summary of COVID-19 losartan studies
1. Götberg et al., Effect of Adding Losartan to Standard of Care Treatment on the Risk of Death and Icu Admission Among Hospitalized COVID-19 Patients: A Randomized Trial
300 patient losartan late treatment RCT: 77% lower ventilation (p=0.01) and 36% lower ICU admission (p=0.24).RCT 302 hospitalized COVID-19 patients showing lower mechanical ventilation but no significant difference in ICU admission or mortality with losartan treatment.
Dec 2022, SSRN Electronic J., https://www.ssrn.com/abstract=4278529, https://c19p.org/gotberg
2. Geriak et al., Randomized Prospective Open Label Study Shows No Impact on Clinical Outcome of Adding Losartan to Hospitalized COVID-19 Patients with Mild Hypoxemia
31 patient losartan late treatment RCT: 6% lower mortality (p=1), 53% lower ICU admission (p=0.6), 53% higher hospital discharge (p=0.6), and 10% shorter hospitalization.RCT 31 hospitalized COVID-19 patients with mild hypoxemia showing no significant difference in mechanical ventilation, ICU admission, or mortality with addition of losartan to standard care.
May 2021, Infectious Diseases and Therapy, https://link.springer.com/10.1007/s40121-021-00453-3, https://c19p.org/geriak
3. Puskarich et al., Efficacy of Losartan in Hospitalized Patients With COVID-19–Induced Lung Injury
205 patient losartan late treatment RCT: 3% higher mortality (p=1), 27% higher ventilation (p=0.47), and 3% lower need for oxygen therapy (p=0.66).RCT 205 hospitalized COVID-19 patients showing no significant difference in lung injury (PaO2:FiO2 ratio) at day 7 with losartan treatment, and no difference in clinical outcomes including mortality. Losartan was associated with more adverse events including acute kidney injury and need for vasopressors. Results suggest losartan is not beneficial and may cause harm in this setting.
Mar 2022, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790162, https://c19p.org/puskarich2
4. Tran et al., Effects of Losartan on Patients Hospitalized for Acute COVID-19: A Randomized Controlled Trial
341 patient losartan late treatment RCT: 14% higher mortality (p=0.69), 1% higher ventilation (p=0.96), 3% higher need for oxygen therapy (p=0.43), and 75% higher ICU admission (p=0.21).RCT 341 hospitalized COVID-19 patients showing significant harm with losartan treatment. The trial was stopped early due to safety concerns after losartan patients experienced significantly higher rates of serious adverse events (39.8% vs 27.2%) and hypotension (30.4% vs 15.3%) compared to usual care, with no mortality benefit.
Jul 2024, Clinical Infectious Diseases, https://academic.oup.com/cid/article/79/3/615/7706430, https://c19p.org/tran3
5. Puskarich et al., A multi-center phase II randomized clinical trial of losartan on symptomatic outpatients with COVID-19
117 patient losartan early treatment RCT: 2% higher ICU admission (p=1), 205% higher hospitalization (p=0.36), and 27% higher progression (p=0.74).RCT 117 symptomatic outpatients showing no significant difference in hospitalization, functional status, dyspnea, or viral load with losartan treatment. The trial was terminated early due to low event rates. Losartan 25mg twice daily for 10 days.
Jul 2021, eClinicalMedicine, https://www.sciencedirect.com/science/article/pii/S2589537021002376, https://c19p.org/puskarich
6. Freilich et al., COVIDMED – An early pandemic randomized clinical trial of losartan treatment for hospitalized COVID-19 patients
12 patient losartan late treatment RCT: 533% higher mortality (p=0.49) and 160% longer hospitalization (p=0.3).RCT 15 hospitalized COVID-19 patients showing no significant differences with losartan treatment. The study was terminated early due to low enrollment.
Oct 2022, Contemporary Clinical Trials Communications, https://www.sciencedirect.com/science/article/pii/S2451865422000850, https://c19p.org/freilich