Metoprolol for the Prevention of Acute Exacerbations of COPD
| Autor: | Sarah M Lindberg, Stephen C. Lazarus, Robert J. Kaner, Elizabeth Westfall, MeiLan K. Han, Allison A. Lambert, David A. Kaminsky, Barry J. Make, Jeffrey L. Curtis, Ken M. Kunisaki, Paul D. Scanlon, Charlene McEvoy, Umur Hatipoğlu, Keith Brenner, Ralph J. Panos, Helen Voelker, Jeremy A. Weingarten, Mark T. Dransfield, John E. Connett, J. Michael Wells, Gerard J. Criner, J. D.Allen Cooper, P. S. Sriram, Richard Casaburi, Carolyn E. Come, Vipul V. Jain, Anthony Smith, Robert M. Reed, Fernando J. Martinez, Matthew R. Lammi, Erika S. Helgeson, Surya P. Bhatt, Ravi Kalhan, Frank C. Sciurba, William W. Stringer |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Kaplan-Meier Estimate 030204 cardiovascular system & hematology Medical and Health Sciences law.invention Pulmonary Disease Chronic Obstructive 0302 clinical medicine Randomized controlled trial law Forced Expiratory Volume 80 and over 030212 general & internal medicine Prospective Studies Treatment Failure Prospective cohort study Lung Metoprolol Aged 80 and over COPD General Medicine Middle Aged Adrenergic beta-1 Receptor Antagonists Hospitalization 6.1 Pharmaceuticals Respiratory Disease Progression Female BLOCK COPD Trial Group medicine.drug medicine.medical_specialty Chronic Obstructive Chronic Obstructive Pulmonary Disease Clinical Trials and Supportive Activities MEDLINE Severe chronic obstructive pulmonary disease Pulmonary Disease 03 medical and health sciences Clinical Research Internal medicine General & Internal Medicine medicine Humans In patient Aged business.industry Evaluation of treatments and therapeutic interventions medicine.disease Observational study business |
| Zdroj: | The New England journal of medicine, vol 381, iss 24 |
| ISSN: | 1533-4406 0258-7351 |
| Popis: | BackgroundObservational 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.MethodsIn 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.ResultsA 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 (FEV1) was 41.1±16.3% of the predicted value. The trial was stopped early because of futility with respect to the primary end point and safety concerns. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days in the metoprolol group and 222 days in the placebo group (hazard ratio for metoprolol vs. placebo, 1.05; 95% confidence interval [CI], 0.84 to 1.32; P = 0.66). Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group.ConclusionsAmong 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.). |
| Databáze: | OpenAIRE |
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