Randomized trial demonstrates no significant clinical benefit of metoprolol in COPD without cardiovascular disease, indicating routine use is unwarranted.
Key Points
To evaluate whether adding metoprolol to standard care improves clinical outcomes in patients with chronic obstructive pulmonary disease who do not have established cardiovascular disease.
Multicenter, open-label, pragmatic, phase 4 randomized trial (NCT03566667) enrolling 1695 patients aged ≥40 years with COPD, sinus rhythm, and no cardiovascular disease.
Participants were randomly assigned 1:1 to receive either standard care alone or metoprolol at a target dose of 100 mg daily plus standard care, with 1 year of follow-up.
The primary end point was time to the first occurrence of a COPD exacerbation, cardiovascular event, or death.
The primary composite end point occurred in 27% of the metoprolol group and 30% of the standard care group (HR, 0.87; 95% CI, 0.73 to 1.05; P=0.14).
Individual components showed no significant reduction with metoprolol: COPD exacerbations (HR, 0.88; 95% CI, 0.72 to 1.06), cardiovascular events (HR, 0.73; 95% CI, 0.48 to 1.11), death (HR, 0.92; 95% CI, 0.48 to 1.77), and hospitalized exacerbations (HR, 0.87; 95% CI, 0.58 to 1.28).
Serious adverse events occurred in 9.4% (80/848) of metoprolol participants compared with 7.8% (66/847) receiving standard care, alongside higher nonserious adverse events (34.6% vs. 29.2%).