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"abstract": "<jats:sec><jats:title>Objectives</jats:title><jats:p>SARS-CoV-2 enters cells using the ACE2 receptor. Medications that affect ACE2 expression or function such as angiotensin receptor blockers (ARBs) and ACE inhibitors (ACE-I) and metformin have the potential to counter the dysregulation of ACE2 by the virus and protect against viral injury. Here, we describe COVID-19 survival associated with ACE-I, ARB and metformin use.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a hospital-based observational study of patients with COVID-19 infection using logistic regression with correction for pre-existing conditions and propensity score weighted Cox proportional hazards models to estimate associations between medication use and mortality.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Medical record data from the US Veterans Affairs (VA) were used to identify patients with a reverse transcription PCR diagnosis of COVID-19 infection, to classify patterns of ACE inhibitors (ACE-I), ARB, beta blockers, metformin, famotidine and remdesivir use, and, to capture mortality.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>9532 hospitalised patients with COVID-19 infection followed for 60 days were analysed.</jats:p></jats:sec><jats:sec><jats:title>Outcome measure</jats:title><jats:p>Death from any cause within 60 days of COVID-19 diagnosis was examined.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Discontinuation of ACE-I was associated with increased risk of death (OR: 1.4; 95% CI 1.2–1.7). Initiating (OR: 0.3; 95% CI 0.2–0.5) or continuous (OR: 0.6; 95% CI 0.5–0.7) ACE-I was associated with reduced risk of death. ARB and metformin associations were similar in direction and magnitude and also statistically significant. Results were unchanged when accounting for pre-existing morbidity and propensity score adjustment.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Recent randomised clinical trials support the safety of continuing ACE-I and ARB treatment in patients with COVID-19 where indicated. Our study extends these findings to suggest a possible COVID-19 survival benefit for continuing or initiating ACE-I, ARB and metformin medications. Randomised trials are appropriate to confirm or refute the therapeutic potential for ACE-I, ARBs and metformin.</jats:p></jats:sec>",
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