Esmolol Outperforms Landiolol in Reducing Mortality in Septic Shock: Study
USA: Researchers have found in a randomized trial that among adults with septic shock, the beta-blocker esmolol showed superior outcomes by significantly reducing 28-day mortality compared to both standard care and landiolol. The randomized trial data were presented at the CHEST Annual Meeting, highlighting the potential role of esmolol in improving survival and key clinical parameters in patients with septic shock.
The comprehensive analysis compared the effectiveness of different beta-blockers in adults with septic shock. The findings revealed that esmolol was associated with the greatest reduction in mortality and overall improvement in clinical outcomes when compared with landiolol or standard therapy.
Septic shock, a critical condition resulting from severe infection and systemic inflammation, continues to carry a high risk of death despite advancements in intensive care management. This leads to circulatory collapse, immune imbalance, and metabolic dysfunction, largely driven by excessive activation of the sympathetic nervous system. Beta-blockers, such as esmolol and landiolol, have been investigated for their potential to counteract these harmful effects by moderating heart rate and enhancing cardiovascular efficiency.
For this analysis, researchers performed a Bayesian network meta-analysis encompassing eight randomized controlled trials involving 916 patients with septic shock. The studies compared the outcomes of patients receiving beta-blockers—either esmolol or landiolol—with those receiving standard care. Statistical models using hazard ratios and mean differences assessed treatment efficacy, while the Surface Under the Cumulative Ranking Curve (SUCRA) method ranked therapies based on their overall performance.
The study revealed the following findings:
- Esmolol ranked highest in reducing 28-day mortality (HR: 0.47), outperforming both the control group (SUCRA: 33.75%) and landiolol (HR: 1.14).
- For ICU mortality, esmolol again showed the greatest benefit (HR: 0.54), while landiolol demonstrated weaker outcomes.
- Esmolol was associated with the shortest ICU stay, with a mean reduction of 1.25 days compared to other treatments.
- It produced the greatest decrease in heart rate, with a mean reduction of 18.35 beats per minute.
- Esmolol was most effective in lowering serum lactate levels, indicating improved metabolic function and recovery.
- Landiolol, on the other hand, showed only modest or minimal improvements across most measured outcomes.
Commenting on the findings, Anika Chowdhury, the CHEST 2025 presenter, stated, “Esmolol may be a promising treatment for septic shock, particularly in patients with heightened sympathetic activation. Its benefits in reducing mortality and improving clinical outcomes support its potential role in practice, though further studies are warranted to confirm its long-term safety and efficacy.”
Overall, esmolol demonstrated consistent advantages in reducing mortality, heart rate, lactate levels, and ICU stay, while landiolol showed limited efficacy. These results underscore esmolol’s emerging role as a potentially valuable adjunct in managing septic shock. The detailed findings will be further discussed during the CHEST Annual Meeting 2025, under the session “Septic Shock: Advancements in Management and Therapeutic Strategies.”
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