Ranolazine's Role in the Treatment of Chronic Stable Angina

Objective: To evaluate the role of ranolazine as an effective and safe first-line treatment option for the management of chronic stable angina (CSA). Data Sources: A literature search was conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane database (publications archived until August 2009) using the terms chronic stable angina and ranolazine. In addition, reference citations from publications identified were reviewed. Study Selection and Data Extraction: English-language, randomized, controlled trials evaluating ranolazine extended release (ER) for the treatment of CSA in humans were selected for review. Four randomized controlled trials were identified. Findings pertaining to efficacy and safety were extracted. Data Synthesis: Three randomized, placebo-controlled CSA studies (N = 191, N = 823, N = 565) and 1 non-ST-segment elevation acute coronary syndrome (ACS) study (N = 6560) were identified that evaluated ranolazine ER. The 3 CSA studies showed that ranolazine ER treatment resulted in statistically significant improvements in exercise tolerance, time to angina onset, and time to 1-mm ST-segment depression. Two of the 3 CSA studies showed statistically significant reductions in angina episodes per week and nitroglycerin use per week compared to placebo. No significant reduction in cardiovascular events was seen in the non-ST-segment elevation ACS study following 1 year of treatment with ranolazine ER. Evidence has demonstrated that monotherapy with ranolazine ER is effective in increasing exercise tolerance in patients with CSA. Ranolazine ER therapy added to traditional antianginal therapy has shown efficacy in increasing exercise tolerance and minimally decreasing angina frequency in clinical trials. Conclusions: Ranolazine ER should be used judiciously in the management of CSA and should not be used as a first-line agent routinely unless traditional therapy is contraindicated.