Metoprolol safe, reduces lung inflammation in patients with
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IV administration of the beta-blocker metoprolol in patients with COVID-19-associated acute respiratory distress syndrome was safe and effective at reducing exacerbated lung inflammation, according to new data.

Severe 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.

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.

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.

-- 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.

-- Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation.

-- Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment whereas it remained unchanged in control subjects.

-- Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group.

Conclusively, 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.