IV Metoprolol safely improves oxygenation in COVID-19 patients with ARDS: Study
Spain: The administration of intravenous metoprolol in critically ill COVID-19 patients with ARDS is safe, improved oxygenation, and reduced exacerbated lung inflammation, show findings from a pilot trial.
The findings, published in the Journal of the American College of Cardiology (JACC), suggest that repurposing beta-blocker metoprolol for COVID-19-associated acute respiratory distress syndrome (ARDS) is a safe and inexpensive strategy that can reduce the burden of the COVID-19 pandemic.
Severe COVID can lead to ARDS which involves alveolar infiltration by activated neutrophils. Previous studies have shown metoprolol to improve exacerbated inflammation in the myocardial infarction setting. Agustín Clemente-Moragón, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, and colleagues aimed to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19–associated ARDS.
The study included a total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation. They were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. Using invasive hemodynamic and electrocardiogram monitoring and echocardiography, the safety of metoprolol administration was evaluated.
The study yielded the following findings:
- Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median: 14.3 neutrophils/µl [Q1, Q3: 4.63, 265 neutrophils/µl] vs median: 397 neutrophils/µl [Q1, Q3: 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively).
- Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (median: 130 [Q1, Q3: 110, 162] vs median: 267 [Q1, Q3: 199, 298] at baseline and day 4, respectively), whereas it remained unchanged in control subjects.
- Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days).
The researchers concluded, "our results show that IV administration of metoprolol to patients with severe COVID-19–associated ARDS is safe and abrogates the exacerbated lung inflammation associated with the disease."
"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," they wrote.
Reference:
The study titled, "Metoprolol in Critically Ill Patients With COVID-19," is published in the Journal of the American College of Cardiology (JACC).
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.07.003
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