Chest pain med is effective for refractory angina, but adherence problematic

Apr 04, 2011

Ranolazine (Ranexa, Gilead) is an effective anti-anginal therapy in patients with refractory angina; however, at one year only 59 percent of patients remained on the drug, according to a scientific poster that will be presented at the American College of Cardiology (ACC) Scientific Sessions in New Orleans, April 1-3.

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 .

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 , 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).

Henry said an approximate 40 percent discontinuation rate is fairly congruent with other medication discontinuation rates, such as statins and antiplatelet therapies. "In challenging economic times, cost is unfortunately going to play a larger role in the medication adherence," he said. "In this study, cost resulted in almost 10 percent of these patients to stop taking the medication." According to the American Academy of Family Physicians, a regimen of 500 mg orally twice-daily ranolazine costs approximately $206 a month.

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.

"Overall, we found that ranolazine is about 85 percent effective," Henry said. "These findings indicate that ranolazine is a reasonable choice for refractory angina, but it also demonstrates how difficult it can be to treat refractory angina."

Explore further: Second bird flu case confirmed in Canada

Provided by Minneapolis Heart Institute Foundation

5 /5 (1 vote)
add to favorites email to friend print save as pdf

Related Stories

Angina drug potentially useful against heart rhythm disorders

Mar 31, 2008

A recently approved angina drug may also represent a powerful new treatment for a rare hereditary syndrome that places teens at risk for sudden cardiac death, according to research presented to today at the 57th Annual Scientific ...

Recommended for you

Second bird flu case confirmed in Canada

14 hours ago

The husband of a Canadian who was diagnosed earlier this week with bird flu after returning from a trip to China has also tested positive for the virus, health officials said Friday.

What exactly is coronavirus?

21 hours ago

The conflicts in Syria and Iraq are straining public health systems and public health efforts meant to prevent and detect the spread of infectious diseases. This is generating a "perfect storm" of conditions for outbreaks. Among the infections raising concern is Middle East Respiratory Syndrome, caused by a type of coronavirus, which emerged in 2012. ...

Scientists find Ebola virus is mutating

21 hours ago

(Medical Xpress)—Researchers working at Institut Pasteur in France have found that the Ebola virus is mutating "a lot" causing concern in the African countries where the virus has killed over eight thous ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.