Experts from the National Center for Cardiovascular Research (CNIC) have described the efficacy of metoprolol – a drug traditionally used for severe diseases of the cardiovascular system – in critical patients with COVID-19. The results have been published in the journal Journal of American College of Cardiology (JACC).
The most serious expression of the coronavirus is severe respiratory failure that requires intubation and is associated with high mortality. In fact, SARS-CoV-2 lung infection can lead to the development of acute respiratory distress syndrome (ARDS), in which neutrophil inflammation or hyperactivation plays a central role. However, for now there is a lack of therapies to treat this syndrome.
The team led by Borja Ibáñez, director of the Translational Laboratory for Cardiovascular Imaging and Therapy of the CNIC, recently discovered that metoprolol 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, the group speculated that this drug could be repositioned as a therapy in severe COVID-19 cases.
In this way, they began a pilot trial together with the Hospital Fundación Jiménez Díaz to study the effect of intravenous treatment with metoprolol on pulmonary inflammatory infiltrate and respiratory function in critically ill patients who have recently been intubated due to ARDS, called MADRID- COVID.
“We studied the inflammatory infiltrate in the bronchoalveolar fluid before and after treatment, as well as the clinical evolution in terms of oxygenation and days under mechanical ventilation,” explains Ibáñez.
Metoprolol improves oxygenation of patients
The results show that treatment with intravenous metoprolol (15 mg / day) for three days “significantly reduced the infiltration of neutrophils in the lungs and improved the oxygenation of the patients”, points out Eduardo Oliver, co-signer of the study.
“We have seen a clear trend: patients receiving this drug needed fewer days under mechanical ventilation and therefore fewer days of admission to the ICU,” says Arnoldo Santos, an intensivist physician and co-author of the study.
Ibáñez clarifies that, “although we must be cautious since it is an initial pilot study, we have observed that the 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 seems to derive in a very rapid improvement in oxygenation. ”
Need to be contrasted with more data
The researchers consider that intravenous metoprolol appears as a “promising intervention that could improve the prognosis of patients with COVID-19 in critical condition” and underline that it is a safe, cheap drug – daily treatment costs less than two euros – and available that can optimize results in severe coronavirus.
“The effect of metoprolol on the hyperactivation of inflammatory cells is unique to this beta-blocker,” says Agustín Clemente-Moragón, co-first signatory of the work.
In fact, the same group of researchers recently showed, in a previous experimental study, that other seemingly similar beta-blockers have no effect on exacerbated lung inflammation.
“Although the study is pilot and needs to be confirmed in a larger trial, its high safety, availability and robust biological effect could be sufficient to assess its use in young patients admitted to the ICU with severe COVID-19”, says Valentín Fuster, director General of the CNIC and co-investigator of this work.