Metoprolol for critical COVID-19 patients
The most serious manifestation of COVID-19 is severe respiratory failure that requires intubation and is associated with high mortality. SARS-CoV-2 lung infection can lead to the development of acute respiratory distress syndrome (ARDS), in which neutrophil inflammation/hyperactivation plays a central role. Currently, there is a lack of therapies to treat ARDS associated with COVID-19.
The team of Dr. Borja Ibáñez, Director of the Translational Imaging and Cardiovascular Laboratory of the National Center for Cardiovascular Research (CNIC) and cardiologist of the Health Research Institute-Jiménez Díaz Foundation (FJD) of Madrid and member of the CIBERCV have recently discovered that Metoprolol, an old beta-blocker drug, has a very selective effect on the hyperactivated neutrophil under acute stress conditions such as myocardial infarction. Due to the central role of neutrophil in ARDS, this team speculated that metoprolol could be repositioned as a therapy in cases of severe COVID-19.
Madrid-COVID is a randomized clinical trial that has been carried out in close collaboration between the CNIC and the cardiology, ICU, pulmonology and biobank services of the FJD Hospital. The main objective of this pilot trial was to study the effect of intravenous metoprolol treatment on pulmonary inflammatory infiltrate and respiratory function in patients with severe COVID-19 who have recently been intubated due to ARDS.
Specifically, explains Dr. Ibáñez, “we gave 20 random patients with severe COVID-19 and recently intubated, intravenous metoprolol (15 mg daily for 3 days) or control (without treatment) in 20 patients.” Dr. Ibáñez emphasizes that “although we must be cautious as this is an initial pilot study, we have observed that treatment with metoprolol in this clinical context is safe, it is associated with a very significant reduction of the pulmonary alveolar inflammatory infiltrate, and this derives in a very rapid improvement of the oxygenation of the patients. Furthermore, we observed that patients who received metoprolol required fewer days of invasive mechanical ventilation.”
The main objective of this pilot trial was to study the effect of intravenous metoprolol treatment on pulmonary inflammatory infiltrate and respiratory function in patients with severe COVID-19 who have recently been intubated due to ARDS
The researchers consider that intravenous metoprolol appears as a “promising intervention that could improve the prognosis of COVID-19 patients who are in critical condition”
Although it must be corroborated in a larger sample, the fact that metoprolol has been a drug used in the clinic for more than 40 years with a very high safety profile in well-selected patients (most patients with COVID-19 are), positions this treatment as an alternative that could help many patients today
Therefore, the researchers consider that intravenous metoprolol appears as a “promising intervention that could improve the prognosis of COVID-19 patients who are in critical condition,” and emphasize that metoprolol is a cheap and clinically available drug (daily treatment costs <2€) that can improve results in patients with severe COVID-19.
Although it must be corroborated in a larger sample, the fact that metoprolol has been a drug used in the clinic for more than 40 years with a very high safety profile in well-selected patients (most patients with COVID-19 are), positions this treatment as an alternative that could help many patients today.
