Metoprolol safe, reduces lung inflammation in patients with severe COVID-19
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IV administration of the beta-blocker metoprolol in patients with COVID-19-associated acute respiratory distress syndrome was safe and effective at reducing exacerbated lung inflammation, according to new data.
“Reduced lung inflammation was associated with a significant improvement in oxygenation and with a trend toward fewer days on mechanical ventilation and of ICU admission,” the researchers wrote.
Agustin Clemente-Moragon, BSc, of the Centro Nacional de Investigaciones Cardiovasculares, Madrid, and colleagues conducted the pilot trial to assess the impact of metoprolol on alveolar inflammation and respiratory function in patients with COVID-19-associated acute respiratory distress syndrome (ARDS).
Clemente-Moragon and colleagues enrolled 20 patients with COVID-19 and ARDS who were on invasive mechanical ventilation and randomly assigned them to metoprolol (15 mg daily for 3 days; n = 12) or no treatment (control; n = 8). Each patient received bronchoalveolar lavage (BAL) before and after metoprolol/control.
Researchers reported no adverse effects to metoprolol administration. Baseline data indicated that neutrophil content in BAL was similar between groups, whereas at day 4, patients receiving metoprolol had less neutrophils in BAL (median, 14.3 neutrophils/µL vs. 397 neutrophils/µL; P = .016).
In addition, metoprolol lowered neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation, defined as the ratio between arterial oxygen partial pressure and fractional inspired oxygen, improved after 3 days in the treatment arm (median, 130 at baseline vs. 267 at day 4; P = .003) but did not improve in the control arm.
Although the following differences did not reach statistical significance, those in the metoprolol group spent less days on invasive mechanical ventilation (15.5 vs. 21.9; P = .17) and had fewer days of ICU admission after enrollment (14.5 vs. 21.4; P = .15).
“Metoprolol repurposing for the treatment of ARDS associated with COVID-19,” Clemente-Moragon and colleagues wrote, “is a safe and cheap intervention that can help to alleviate the massive personal and health care burden associated with the pandemic.”
Mourad H. Senussi, MD, MS, of Baylor St. Luke’s Medical Center, wrote in an accompanying editorial that the findings shed light on the important pathophysiologic underpinnings that help establish biological plausibility for this inexpensive, safe and widely available medication.
“Although observed in patients with COVID-19, this sets the groundwork for further research in the use of beta-blockade in the critically ill,” Senussi wrote. “Further studies are needed to elucidate and identify where along the inflammatory spectrum these critically ill patients lie, which patients would benefit from beta-blockers and at what time point during their hospital stay.”
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