M. Dransfield, H Voelker, S. Bhatt et al.
N Eng J Med 2019; 381:2304-2314 DOI: 10.1056/NEJMoa1908142 December 12, 2019
In this prospective, randomized trial, 532 patients between 40 and 85 years with COPD (mean FEV1 was 41.1±16.3% of the predicted value) and without an established indication for beta-blocker use were assigned to receive either a beta-blocker (extended-release metoprolol) or placebo. 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) but Metoprolol was associated with a higher risk of exacerbation leading to hospitalisation (hazard ratio, 1.91; 95% CI, 1.29 to 2.83).There were 11 deaths in the metoprolol group and 5 in the placebo group.