当前位置:科学网首页 > 小柯机器人 >详情
美托洛尔无益于预防COPD急性加重
作者:小柯机器人 发布时间:2019/10/23 17:02:29

美国阿拉巴马大学Mark T. Dransfield领衔的科研团队在最新研究中探讨了美托洛尔是否可预防COPD急性加重。相关论文10月20日在线发表于《新英格兰医学杂志》。

据悉,β受体阻滞剂可以降低中重度慢性阻塞性肺病(COPD)患者病情恶化和死亡的风险,但这些发现尚未在随机试验中得到证实。

在这项前瞻性随机试验中,研究组招募了532名40-85岁的COPD患者,平均1秒用力呼气量(FEV1)为预测值的41.1%,将其随机分为β受体阻滞剂(长效美托洛尔)组和安慰剂组。所有患者均伴有COPD中度气流限制和加重的风险,如前一年的加重史或按规定补充氧气。排除已服用β受体阻滞剂或类似药物的患者。主要终点是治疗期间COPD首次加重的时间。

美托洛尔组COPD首次加重的时间为202天,安慰剂组为222天,差异无显著性。美托洛尔组因COPD加重而住院的风险显著升高,风险比为1.91。两组中可能与美托洛尔有关的副作用发生率相似,非呼吸性严重不良事件的总发生率也相似。在治疗期间,美托洛尔组有11例患者死亡,安慰剂组有5例。

对于没有明确的β受体阻滞剂使用指征的中重度COPD患者,美托洛尔组和安慰剂组COPD首次加重的时间相似。且美托洛尔组中因病情恶化住院更为常见。

附:英文原文
 
Title:Metoprolol for the Prevention of Acute Exacerbations of COPD
 
Author:Mark T. Dransfield, M.D., Helen Voelker, B.A., Surya P. Bhatt, M.D., Keith Brenner, M.D., Richard Casaburi, M.D., Carolyn E. Come, M.D., J. Allen D. Cooper, M.D., Gerard J. Criner, M.D., Jeffrey L. Curtis, M.D., MeiLan K. Han, M.D., Umur Hatipo?lu, M.D., Erika S. Helgeson, Ph.D., et al., for the BLOCK COPD Trial Group*
 
Issue&Volume:October 20, 2019
 
Abstract: 
 
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 (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.

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.
 
DOI:10.1056/NEJMoa1908142
 
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1908142

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home