The efficacy and safety of pharmacological treatments in patients with hypertrophic cardiomyopathy: a network meta-analysis

Background Hypertrophic cardiomyopathy is a common inherited heart disease and the first to identify its genetic basis. Currently, there are no specific drugs for patients with hypertrophic cardiomyopathy (HCM), and attempts have been made to evaluate whether various drugs are beneficial for the treatment of HCM. Methods Web of Science, PubMed, and Embase databases for randomized controlled trials (RCTs) were systematically searched from inception to March 10, 2023. A network meta-analysis with a Bayesian framework with Aggregate Data Drug Information System (ADDIS, version 1.16.8) was conducted to assess the clinical outcomes of pharmacological interventions. The odds ratio (OR) was employed for the dichotomous effects, and the mean difference (MD) was used for the continuous effects, both of which were featured with 95% confidence interval (CI). Results A total of 8 trials were included, including 899 patients. We found that the incidence of palpitations for ranolazine was lower than that for mavacamten (0.00 (0.00, 0.45)) and placebo (0.00 (0.00, 0.33)). The incidence of palpitations for trimetazidine was higher than that for ranolazine (2.22e + 13 (343.85, 3.81e + 32)). The incidence of headache for trimetazidine was higher than that for ranolazine (390457.40 (1.53, 5.2e + 16)). Conclusion In addition to trimetazidine, HCM patients had the lowest incidence of syncope, but it was more likely to cause dizziness. All other drugs are safe to use. Ranolazine might have the lowest incidence of palpitations and headache. Systematic review registration PROSPERO CRD42023398778.