Landiolol 300mg powder for solution for infusion vials

Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary.

Abstract licence: CC BY 4.0

Landiolol is being investigated for its potential to manage septic shock (SS) and sepsis-related tachyarrhythmias (TA). We performed a systematic review and meta-analysis of three randomized controlled trials (RCTs) involving 473 patients with sepsis or SS, including those with TA, comparing landiolol to standard therapy-controlled (STC) groups. Standard therapy consisted of usual sepsis care ± placebo but excluded β-blockers in the control arms. MEDLINE, Embase, and Cochrane databases were searched for trial data extracted from published reports up to November 2024, excluding non-English reports. Quality assessment was performed per Cochrane recommendations. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled across trials to evaluate the outcomes. The primary endpoints included heart rate (HR) at 96 hours, chosen because all three trials consistently recorded HR at this time point, allowing for uniform comparison despite additional time points being reported, and 28-day mortality. Secondary outcomes included atrial fibrillation (AF), hypotension, changes in Sequential Organ Failure Assessment score, and norepinephrine dose. Of the three RCTs, 473 patients were included, with an intervention-to-control arm ratio of approximately 1:1. A lower HR (MD: -6.36; 95% CI: -9.25, -3.47; p < 0.0001; I² = 0%) was observed in the landiolol group compared to the STC. Hypotension (RR: 3.62, 95% CI: 1.37, 9.58; p = 0.010; I² = 5%) was significantly increased in patients who received landiolol when compared to STC, and 28-day mortality showed no significant difference between the groups (RR: 1.07; 95% CI: 0.72, 1.58; p = 0.74; I² = 44%), as did AF (RR: 0.63; 95% CI: 0.25, 1.59; p = 0.33; I² = 8%). Landiolol, a highly selective ultrashort-acting β1-blocker with distinct pharmacokinetic properties from esmolol, reduces HR in patients with sepsis-related TA without significantly affecting 28-day mortality. However, careful monitoring for hypotension is advised, given the absolute risk increase of 8.4% observed in treated patients. However, results should be interpreted cautiously as only three small trials underpin these results. To our knowledge, this is the first MA to focus exclusively on landiolol in this setting, offering drug-specific insights for critical care management.

Abstract licence: CC BY

Objectives: The clinical efficacy of short-acting β-blockers in the management of sepsis remains uncertain. In particular, the comparative effects of two commonly used agents—esmolol and landiolol—have not been clearly established. This network meta-analysis aims to systematically evaluate and compare the effects of esmolol, landiolol, and standard of care (SOC) on mortality in patients with sepsis. Data Sources: A systematic search of PubMed, Web of Science, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, preprints, and citation searching was conducted before April 15, 2025. Study Selection: Randomized controlled trials that enrolled adult patients (≥ 18 yr) diagnosed with sepsis or septic shock and treated with β-blockers and conducted in ICUs. Data Extraction: Data were extracted on study characteristics, enrolled patients’ characteristics, administration strategies of drugs, and key clinical outcomes (including 28-d mortality, ICU length of stay, and other relevant endpoints). Data Synthesis: A total of 1165 records were identified through searches of five databases, registries, and relevant references up to April 15, 2025. Ten studies involving 1035 patients were included, after screening and eligibility assessment. Compared with esmolol, landiolol was associated with increased 28-day mortality (relative risk [RR], 1.57; 95% CI, 1.08–2.30; low certainty) and higher norepinephrine requirements (mean difference [MD], 0.17 μg/kg/min; 95% CI, 0.02–0.32; low certainty). Esmolol significantly reduced 28-day mortality (RR, 0.69; 95% CI, 0.56–0.85; moderate certainty) and 24-hour heart rate (MD, –16.92 beats/min; 95% CI, –23.49 to –10.36; moderate certainty) compared with SOC. In contrast, landiolol increased norepinephrine use compared with SOC (MD, 0.09 μg/kg/min; 95% CI, 0.01–0.18; moderate certainty). Conclusions: Among patients with sepsis treated with β-blockers, esmolol probably improves clinical outcomes compared with SOC. However, the effect of landiolol remains uncertain due to the low certainty of evidence. Esmolol may confer a relative clinical advantage over landiolol, but further studies are needed to confirm this finding and elucidate the underlying mechanisms.

Abstract licence: CC BY-NC-ND

Landiolol is an intravenous ultra-short acting beta-blocker which has been used in Japan for many years to prevent and/or to treat post-operative atrial fibrillation following cardiac surgery. The drug is now available in Europe. This article is a systematic review of literature regarding the use of landiolol in that specific surgical setting.

Abstract licence: CC BY-NC 4.0