Metoprolol in Critically Ill Patients With COVID-19 #MMPMID34474731
Clemente-Moragon A; Martinez-Milla J; Oliver E; Santos A; Flandes J; Fernandez I; Rodriguez-Gonzalez L; Serrano Del Castillo C; Ioan AM; Lopez-Alvarez M; Gomez-Talavera S; Galan-Arriola C; Fuster V; Perez-Calvo C; Ibanez B
J Am Coll Cardiol 2021[Sep]; 78 (10): 1001-1011 PMID34474731show ga
BACKGROUND: Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. OBJECTIVES: The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS. METHODS: A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation 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. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography. RESULTS: 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/microl [Q1, Q3: 4.63, 265 neutrophils/microl] vs median: 397 neutrophils/microl [Q1, Q3: 222, 1,346 neutrophils/microl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO(2):FiO(2)) 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; P = 0.003), 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; P = 0.17). CONCLUSIONS: In this pilot trial, intravenous metoprolol administration to patients with COVID-19-associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19-associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
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J+Am+Coll+Cardiol 2021 ; 78 (10): 1001-1011
