Mechanistic Clinical Trial Comparing the Pharmacokinetics/Pharmacodynamics of Metoprolol in Heart Failure With Reduced Ejection Fraction Patients With Low vs. High Polygenic Score

Personalizing Heart Failure Treatment With Genomics: A Clinical Trial to Understand the Mechanisms and Validate a Polygenic Risk Score for Beta-Blocker Response

The purpose of this trial is to better understand how the beta-blocker metoprolol works in people with Heart Failure with Reduced Ejection Fraction (HFrEF) according to participants genetics. Participants will have the beta-blocker (BB) polygenic score calculated from genotype data. The score will be used to stratify the patients in the low and high polygenic score groups in the study.

The hypotheses for this trial are:

• HFrEF patients with high polygenic score will have weaker cardiovascular responses to metoprolol succinate than HFrEF patients with low polygenic score.
• HFrEF patients with high polygenic score have lower steady-state plasma concentrations of metoprolol succinate than HFrEF patients with low polygenic score.
• HFrEF patients with high polygenic score require higher metoprolol succinate plasma concentrations to achieve similar cardiovascular effects as those with low polygenic score.

Study Overview

• Status: Recruiting
• Conditions: Heart Failure With Reduced Ejection Fraction
• Intervention / Treatment: Drug: Metoprolol Succinate; Device: Beta-Blocker Polygenic Score; Device: Illumina Infinium Global Diversity Array with Enhanced Pharmacogenomics (PGx)

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Diamond Thomas; Phone Number: 734-615-4532; Email: diamthom@med.umich.edu

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • Recruiting
      • University of Michigan
      • Contact: Jamine Luzman, PharmD, PhD; Phone Number: 734-615-4851; Email: jluzum@med.umich.edu
      • Principal Investigator: Jasmine Luzum, PharmD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Heart Failure with Reduced Ejection Fraction (HFrEF)
• Has not taken a beta-blocker within the past 6 months (preferred), or if needed to meet enrollment target, patients that have not taken a beta-blocker in the past 3 months, or only taken a low dose of beta-blocker within the past 6 months (i.e., < 50% of the guideline-recommended HFrEF target dose, or for beta-blockers that are not approved for HFrEF, <50% of the maximum dose)
• Genetic data already available to calculate the polygenic score (e.g., through participation in the Michigan Genomics Initiative (MGI) or other genetic tests) or willingness to provide a deoxyribonucleic acid (DNA) sample for genetic analysis
• White race
• Has been prescribed a stable dose (including no dose) of angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), ARB-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 (SGLT-2) inhibitor, or mineralocorticoid receptor antagonist (MRA) for at least the past 4 weeks
• Has been prescribed a stable dose (including no dose) of diuretic(s) for at least the past 2 weeks
• For women of child-bearing potential: the participant is willing to perform a pregnancy test and use a highly effective contraceptive method for at least 4 weeks prior to the start of metoprolol treatment, during the entire metoprolol treatment period, and for at least 5 days after the discontinuation of metoprolol treatment
• Ability to understand and willing to sign a written informed consent

Exclusion Criteria:

• Prior heart transplant or left ventricular assist device (LVAD) or planned within treatment period
• Planned implantation of a pacemaker or Cardiac Resynchronization Therapy (CRT) during treatment period
• Patients with a pacemaker that does not allow their heart rate to change in response to exercise per protocol
• Pregnant
• Systolic blood pressure < 95 millimeters of mercury (mmHg)
• Heart rate < 60 beats per minute
• Second (Mobitz II)- or third-degree heart block
• Cardiogenic shock
• Patients with acute decompensated heart failure requiring current hospitalization or immediate medical intervention.
• Sick sinus syndrome
• Pheochromocytoma
• Known hypersensitivity to the metoprolol succinate oral tablet used in the trial
• Hypertrophic obstructive cardiomyopathy
• Active myocarditis
• Acute coronary syndrome within the past month
• Active or uncorrected severe mitral or aortic valvular dysfunction
• Patients with known severe congenital heart disease per protocol
• Child-Pugh Class C liver disease
• Patients with end-stage renal disease (ESRD) requiring hemodialysis
• Concomitant disease that prohibits participating in Cardiopulmonary Exercise Test (CPET) per protocol
• Concomitant disease with expected survival less than the duration of the study (e.g., metastatic cancer)
• Current or planned treatment with cardiotoxic medications, including interferons and the cancer therapies per protocol
• Concurrent participation in another clinical trial that may affect participant safety or validity of data collected in this clinical trial
• Inability to take oral medication

• Unwilling or unlikely to adhere to the study procedures, as determined at the discretion of the study team, including but not limited to the following reasons:

  1. Psychiatric illness or other comorbidities
  2. Substance abuse
  3. Social or logistical circumstances

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Metoprolol succinate; Treatment will be given for approximately 6 months

Drug: Metoprolol Succinate; Participants will be given daily metoprolol and the dose will be titrated up to 200 milligrams daily (over 6-12 weeks) or the maximum tolerated dose. Once this dose is reached treatment will continue for approximately 5-8 months. In addition, participants, will have various visits that include laboratory and cardiac testing at certain time points.; Other Names: Lopressor; Toprol-Extended Release (XL); Device: Beta-Blocker Polygenic Score; The purpose of the beta-blocker polygenic score is to predict which HFrEF patients will respond better to beta-blocker therapy. It will be used to stratify the patients in the low and high polygenic score groups in the study. There are no post-manufacturing modifications to the score.; Device: Illumina Infinium Global Diversity Array with Enhanced Pharmacogenomics (PGx); If the participant does not already have genotype data available through Michigan Genomics Initiative (MGI), then this device will be used to genotype DNA sample, which will be used to calculate the polygenic score. There are no post-manufacturing modifications to the device.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Half Maximal Effective Concentration of Change in Exercise-Induced Heart Rate (EC50 of ΔEIHR)	The plasma concentration of s-metoprolol succinate that causes 50% of the change in exercise-induced heart rate.	Baseline to approximately 6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in left ventricular ejection fraction (LVEF)	Baseline to approximately 6 months
Area Under the Curve from 0 to 24 hours s-metoprolol plasma concentration-time curve "at steady state"	Approximately 6 months
Maximum tolerated dose of metoprolol succinate (total daily dose in milligram)	Approximately 6 months

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI)
• Investigators: Principal Investigator: Jasmine Luzum, PharmD, PhD, University of Michigan

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): July 1, 2029
• Study Completion (Estimated): July 1, 2029

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 24, 2026

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Pharmacokinetic; Pharmacodynamics; Pharmacogenomics; Polygenic Risk Score; Pharmacogenetic; Beta-blocker; Cardiac testing
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Disease Susceptibility; Genetic Predisposition to Disease; Pathological Conditions, Signs and Symptoms; Genetic Risk Score; Organic Chemicals; Amines; Alcohols; Phenoxypropanolamines; Propanolamines; Amino Alcohols; Propanols; Metoprolol
• Other Study ID Numbers: HUM00266021; 1R01HL178410-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No