Losartan with add-on spironolactone for severe COVID-19 in the intensive care unit: a randomized controlled trial
In brief
Losartan-based treatment showed no clear benefit in 78 patients with severe COVID-19
In this randomized trial, adding losartan, with spironolactone for some patients, did not significantly improve day 7 organ failure scores: median scores were 3 with standard care and 2 with treatment. Intubation, ventilation duration, 90-day mortality, and safety were also similar, but early termination left the trial too small to rule out a treatment effect.
- Journal
- Respiratory medicine (Q1)
- Published
- 25 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Pierre Simeone, Julien Carvelli, Jeanne Morel, Imane Inal, Francois Silhol, Bernard Vaïsse, et al.
- PMID
- 42790654
- DOI
- 10.1016/j.rmed.2026.109175
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 27 September 2026): Losartan ± spironolactone did not improve SOFA scores
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 27 September 2026): Losartan ± spironolactone no SOFA benefit
Abstract
BACKGROUND: The Coronavirus disease (COVID-19) pandemic caused significant mortality, predominantly among patients with comorbidities. Management of critically ill patients relies mainly on supportive care. SARS-CoV-2 influences the renin-angiotensin system, a potential therapeutic target. The aim was to evaluate whether losartan and spironolactone, added to standard care, improve organ failure and other clinical outcomes in patients with severe COVID-19 admitted to intensive care units. We designed a randomized, open-label, parallel-group trial, in five intensive care units in Marseille, France, from September 2020 to September 2021. METHODS: Adults with COVID-19-related respiratory distress were randomized. The experimental group received standard care plus losartan and conditional addition of spironolactone for 10 days while the control group received standard care alone. The primary endpoint was the SOFA-score on day 7. Secondary endpoints included SOFA scores at other time points, intubation rates, mechanical ventilation duration, 90-day mortality, viral replication, and safety. RESULTS: 78 patients were randomized (39 in the control group, 39 in the experimental group); the primary outcome was analysed in 73 patients (the modified intention-to-treat population comprised 74; one experimental patient died on day 6). We found no significant difference in median SOFA-score on day 7 between the groups (3 vs 2; p = 0.5). There were no significant differences in intubation rates, mechanical ventilation duration, 90-day mortality, or adverse events. Viral replication and oxygenation parameters were also similar. CONCLUSION: This trial did not detect a statistically significant treatment effect of losartan, with spironolactone added in a minority of patients, on clinical outcomes in COVID-19 ICU patients. However, the trial was underpowered due to early termination.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.