Abstract 15298: Relative Efficacy of Antianginal Drugs Used in an Add-On Role in Patients with Stable Angina. Systematic Review and Meta-Analysis
Objective: Medical management of stable angina generally involves a beta blocker (BB) or calcium channel blocker (CCB) as first line, with agents from other classes being added on if symptom control is inadequate. Evidence supporting the appropriate choice of second-line agent is currently unclear. The objective of this systematic review was to quantify the relative clinical efficacy of BB, CCBs, ranolazine, long-acting nitrates (LAN), nicorandil or ivabradine added on to first line therapy.
Method: A comprehensive literature search was carried out to identify randomised controlled trials comparing the use of a licensed antianginal therapy versus either placebo or an agent from another drug class, in patients with stable angina who were symptomatic on first line therapy with either a BB or CCB. Data on exercise tolerance test (ETT) and clinical outcomes were extracted and combined in a series of random effects meta-analyses.
Results: The search identified 37 qualifying studies evaluating 61 treatment comparisons. The most frequent combinations evaluated were CCB added to BB (n=37; 2468 pts) and BB added to CCB (n=12; 1489 pts). The remaining comparisons evaluated LAN added to either BB (n=5; 197 pts) or CCB (n=3; 132 pts), ivabradine added to BB (n=1; 889 pts) and ranolazine added to either BB or CCB (n=3; 1388 pts). No qualifying studies were identified for nicorandil in an add-on role. Mean weekly attack frequency on baseline therapy was 5.4 (sd:4.0; range 0.5-14.7). Results for the meta-analysis of the three main ETT outcomes and two clinical outcomes are summarised in the table below.
Conclusion: Across a broad range of commonly assessed exercise and clinical outcomes, there are no data for nicorandil; long acting nitrates show inconsistent and generally insignificant effects, whilst the combination of BB and CCB with each other or one of them with ranolazine show significant improvement in exercise and clinical outcomes. Table: summary of results of meta-analyses.
- © 2012 by American Heart Association, Inc.