Ranolazine, an anti-anginal drug was found to be effective for treating refractory angina (RA) patients in a study, but discontinued ranolazine usage was also seen among patients in the study. Patients with refractory angina, who have chronic chest pain but are not candidates for revascularization, have limited therapeutic options and significant limitations in their quality of life, the study authors wrote. Conversely, patients with chronic angina are often candidates for a procedure.
Ranolazine is approved for patients with chronic stable angina but has not been studied in refractory angina. The prospective Ranolazine Refractory Angina Registry Trial was designed to evaluate the safety, tolerability and effectiveness in RA patients.
"Refractory angina is a challenging and increasingly common clinical problem. These patients are often identified as ’no option patients’ due to the lack of treatment choices," explained the study’s senior author Timothy D. Henry, MD, interventional cardiologist at Minneapolis Heart Institute� at Abbott Northwestern Hospital in Minneapolis.
In order to assess ranolazine for this patient population, the researchers enrolled 100 consecutive patients with class 3 or class 4 angina who were not candidates for revascularization.
The drug was found to be effective in more than 80 percent of patients, but at one year, only 59 percent of the patients remained on ranolazine. Of those remaining on ranolazine, 56 percent had at least a two class improvement in angina.
In the 41 patients who discontinued ranolazine usage, the reasons included: side effects which ranged from lightheadedness, numbness, tingling and constipation (15 patients); major adverse cardiac events, including heart attack (seven patients) or death (two patients); cost (five patients); ineffective (six patients); cost and ineffective (three patients); and for unknown reasons (two patients).
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Also, hospitalization due to angina was similar in the group that discontinued the medication and those patients that remained on ranolazine (32.5 percent versus 32.8 percent, respectively). "The high rate of hospitalization was not surprising but it was disappointing that an effective anti-anginal medication did not decrease the hospitalization rate," Henry said.
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Source-Eurekalert