Metoprolol for the Prevention of Acute Exacerbations of COPD.
Adrenergic beta-1 Receptor Antagonists
/ adverse effects
Aged
Aged, 80 and over
Disease Progression
Female
Forced Expiratory Volume
Hospitalization
/ statistics & numerical data
Humans
Kaplan-Meier Estimate
Male
Metoprolol
/ adverse effects
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive
/ drug therapy
Treatment Failure
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
12 12 2019
12 12 2019
Historique:
pubmed:
22
10
2019
medline:
3
1
2020
entrez:
22
10
2019
Statut:
ppublish
Résumé
Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials. In this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All the patients had a clinical history of COPD, along with moderate airflow limitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending on the adjusted dose of metoprolol. A total of 532 patients underwent randomization. The mean (±SD) age of the patients was 65.0±7.8 years; the mean forced expiratory volume in 1 second (FEV Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol. (Funded by the Department of Defense; BLOCK COPD ClinicalTrials.gov number, NCT02587351.).
Sections du résumé
BACKGROUND
Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.
METHODS
In this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All the patients had a clinical history of COPD, along with moderate airflow limitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending on the adjusted dose of metoprolol.
RESULTS
A total of 532 patients underwent randomization. The mean (±SD) age of the patients was 65.0±7.8 years; the mean forced expiratory volume in 1 second (FEV
CONCLUSIONS
Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol. (Funded by the Department of Defense; BLOCK COPD ClinicalTrials.gov number, NCT02587351.).
Identifiants
pubmed: 31633896
doi: 10.1056/NEJMoa1908142
pmc: PMC7416529
mid: NIHMS1614928
doi:
Substances chimiques
Adrenergic beta-1 Receptor Antagonists
0
Metoprolol
GEB06NHM23
Banques de données
ClinicalTrials.gov
['NCT02587351']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2304-2314Subventions
Organisme : NHLBI NIH HHS
ID : K24 HL140108
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL148215
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002384
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007563
Pays : United States
Investigateurs
Allen Cooper
(A)
Patti Smith
(P)
Carolyn E Come
(CE)
Christina M Mercugliano
(CM)
Erick S MacLean
(ES)
Emily A Holmes
(EA)
Kevin M Zinchuk
(KM)
Ralph Panos
(R)
Kimberly Kersey
(K)
Laura Lach
(L)
Umur Hatipoglu
(U)
Amy Attaway
(A)
Anu Suri
(A)
Mohammed Al-Jaghbeer
(M)
Sudhir Dudekonda
(S)
Muhammad Raza
(M)
Richard Rice
(R)
Jenna Brinker
(J)
Keith Brenner
(K)
Immani Easthausen
(I)
M Atif Choudhury
(MA)
Maahika Srinivasan
(M)
Sana Sajjad
(S)
Onumara Opara
(O)
Charlene E McEvoy
(CE)
Pamela J Neuenfeldt
(PJ)
Cheryl Sasse
(C)
W Stringer
(W)
R Casaburi
(R)
H Rossiter
(H)
J Porszasz
(J)
L Diaz
(L)
R Indelicato
(R)
C Lopez-Garcia
(C)
R Calmelat
(R)
D Cavanaugh
(D)
Matthew R Lammi
(MR)
Connie Romaine
(C)
Marie Sandi
(M)
Paula Lauto
(P)
Paul D Scanlon
(PD)
Jeremy Clain
(J)
Alexander Niven
(A)
Megan Dulohery Scrodin
(M)
Boleyn Andrist
(B)
Alana English
(A)
Tami S Krpata
(TS)
Ken Kunisaki
(K)
Megan Campbell
(M)
Miranda DeConcini
(M)
Anne Melzer
(A)
Chris Wendt
(C)
Erin Wetherbee
(E)
Doug DeCarolis
(D)
Barry Make
(B)
Steven Lommatzsch
(S)
Amen Sergew
(A)
Jennifer Underwood
(J)
Robert J Kaner
(RJ)
Fernando J Martinez
(FJ)
Ben-Gary Harvey
(BG)
Daniel Libby
(D)
Laura Libby
(L)
Brian Gelbman
(B)
David Chappell Weir
(D)
Andrea Shioleno
(A)
Jamuna Krishnan
(J)
William Zhengyang Zhang
(W)
Elizabeth Peters
(E)
Alicia J Morris
(AJ)
Matthew Marcelino
(M)
Jeremy Weingarten
(J)
Anthony Saleh
(A)
Saleem Shahzad
(S)
Liziamma George
(L)
Liam Gross
(L)
Puja Chadha
(P)
Christina Edwards
(C)
Anthony Smith
(A)
Susan Ingenito
(S)
Ravi Kalhan
(R)
Sharon Rosenberg
(S)
Lewis Smith
(L)
Jenny Hixon
(J)
Allison Rogowski
(A)
Alyssa Frederick
(A)
Allison A Lambert
(AA)
Radica Alicic
(R)
Thomas DeCato
(T)
Lisa Davis
(L)
David Lebo
(D)
Michael Jacobs
(M)
Gerard Criner
(G)
Nathaniel Marchetti
(N)
Helga Criner
(H)
Dee Fehrle
(D)
Joseph Lambert
(J)
Mark Dransfield
(M)
Surya Bhatt
(S)
J Michael Wells
(JM)
Anand Iyer
(A)
Trisha Parekh
(T)
Steven Lloyd
(S)
Gregory Payne
(G)
Samuel McElwee
(S)
Elizabeth Westfall
(E)
Keenya Mathews
(K)
Renita Holmes
(R)
Vipul Jain
(V)
Dennis Richard Allison
(DR)
John McClain
(J)
Janna Blaauw
(J)
Griselda Aguilar
(G)
Alexa Lopez
(A)
Stephen C Lazarus
(SC)
Prescott G Woodruff
(PG)
Julian Silva
(J)
Robert Reed
(R)
Giora Netzer
(G)
Archana Patel
(A)
Maura Deeley
(M)
Saif M Borgan
(SM)
Sadam Haddadin
(S)
Hasan Radhi
(H)
Hassan A Haji
(HA)
Nirali Marvania
(N)
MeiLan K Han
(MK)
Wassim Labaki
(W)
Mary Kay Hamby
(MK)
John E Connett
(JE)
Chris Wendt
(C)
Sarah Lindberg
(S)
Helen Voelker
(H)
Irene Olson
(I)
Frank Sciurba
(F)
Divay Chandra
(D)
Jessica Bon Field
(J)
Michael Emmet O'Brien
(ME)
Craig Riley
(C)
Paula Consolaro
(P)
Megan D'Innocenzo
(M)
Kelsey Elliott
(K)
Christina Ledezma
(C)
Jenna Smith
(J)
Elizabeth Stempkowski
(E)
Daniel Arminavage
(D)
Robert Wilson
(R)
Rhonda Lincoln
(R)
David A Kaminsky
(DA)
Erika Gonyaw
(E)
Chloe Housenger
(C)
Kevin Hodgdon
(K)
Heidi Pecott-Grimm
(H)
Jeffrey L Curtis
(JL)
Lisa McCloskey
(L)
Nadia Hansel
(N)
Vera Bittner
(V)
James Tonascia
(J)
Sandy Snyder
(S)
Usamah Kayyali
(U)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Massachusetts Medical Society.
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