Landiolol Reduces and Maintains Heart Rate in Septic Shock

TOPLINE:

Landiolol reduces and maintains heart rate for 24 hours without increasing the need for vasopressors in patients with septic shock and persistent tachycardia.

METHODOLOGY:

• Researchers conducted a multicenter, randomized, open-label, controlled trial in 196 intensive care unit (ICU) adult patients with septic shock and persistent tachycardia at 20 sites in seven European countries between 2018 and 2022.
• The patients were randomly assigned to receive either standard treatment alone (n = 98) or landiolol with standard treatment (n = 98).
• The primary outcome was a heart rate response (maintenance of a heart rate of 80-94 beats per minute) without an increase in vasopressor requirement in the first 24 hours of treatment.
• The secondary outcomes were 28-day mortality, adverse events, and changes in vasopressor requirements throughout the study period.

TAKEAWAY:

• Heart rate reduction and maintenance without increased vasopressor use was achieved in 39.8% of the patients treated with landiolol vs 23.5% in the control group (P =.013).
• Target heart rate reduction was achieved in 75.5% of those in the landiolol group vs 42.9% of those in the control group (P<.001>
• The two groups showed no significant difference in 28-day mortality (P = .20) or ICU or hospital stay duration.

IN PRACTICE:

“The highly selective, ultrashort-acting beta-1-blocker landiolol in patients with septic shock and persistent tachycardia was effective in reducing and maintaining HR [heart rate] without increasing vasopressor requirements within the first 24 h. There were no differences in adverse events and clinical outcomes such as 28-day mortality vs sole standard of care,” the authors wrote.

SOURCE:

The study was led by Sebastian Rehberg, University Hospital of Bielefeld, Bielefeld, Germany. It was published online on September 19 in Intensive Care Medicine.

LIMITATIONS:

The trial was limited by its open-label design and the lack of detailed hemodynamic monitoring, which may have led to the potential involvement of patients with compensatory sinus tachycardia who did not benefit from heart rate reduction. Evaluation of the effect of landiolol on cardiac function was limited, and the primary endpoint was not validated as a surrogate marker for clinical outcomes. The study was conducted during the COVID-19 pandemic, which may have impacted patient care.

DISCLOSURES:

The study was funded by AOP Orphan Pharmaceuticals GmbH, and open access funding was provided by Projekt DEAL. Five authors reported being employees of AOP Orphan Pharmaceuticals GmbH. One author declared being a Board Director of AOP Health International Management AG. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.