What is the Safety, Efficacy of Metoprolol Therapy in Critically Ill COVID-19 Patients?

Intravenous metoprolol therapy may safely reduce lung inflammation and improve oxygenation for COVID-19 patients with acute respiratory distress syndrome (ARDS), according to results of the MADRID-COVID pilot trial published Aug. 30 in the Journal of the American College of Cardiology.

Agustín Clemente-Moragón, BSc, et al., assessed the effects of intravenous metoprolol therapy on respiratory function and alveolar inflammation in 20 COVID-19 patients with ARDS using electrocardiogram monitoring and echocardiography. Each patient was on invasive mechanical ventilation and randomized to either 15 mg metoprolol daily or control treatment. Before and after their treatment, each patient had bronchoalveolar lavage (BAL).

The results showed that metoprolol therapy produced no side effects, and there were no variations at baseline in the neutrophil content in BAL between the two groups. On day four, patients who received metoprolol therapy displayed noticeably fewer neutrophils in BAL than those in the control group. Metoprolol therapy reduced markers of lung inflammation, such as neutrophil extracellular traps content. It also noticeably improved oxygenation after three days of treatment. These variables were unaffected in the control group.

“Future studies with larger sample sizes are needed to confirm the benefit of metoprolol in critically ill patients with COVID-19 and potentially other inflammatory etiologies of acute respiratory distress syndrome,” the authors conclude.

In a related editorial comment, Mourad H. Senussi, MD, MS, states that “this study uses a readily available, safe, and inexpensive medication, has a simple study design and most importantly shows biological plausibility. Although observed in COVID-19 patients, this sets the groundwork for further research in the use of beta blockade in the critically ill. 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.”

“This is a preliminary study looking at mechanisms of potential benefit but requires far more study,” adds Kim A. Eagle, MD, MACC, editor in chief of ACC.org.

Clinical Topics: COVID-19 Hub, Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: Metoprolol, Neutrophils, Respiration, Artificial, COVID-19, Pneumonia, Bronchoalveolar Lavage, Inflammation, Echocardiography, Electrocardiography

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