Is One Anti-Anginal Drug More Effective than Another for Stable Angina?

Researchers performed a meta-analysis that included patients being treated for stable angina with monotherapy
Researchers performed a meta-analysis that included patients being treated for stable angina with monotherapy

WASHINGTON, DC—While numerous treatment options are available for the management of stable angina, there is yet to be consensus on which is the preferred agent. To determine the relative efficacy of these anti-anginal agents, study leader Rhynn Malloy, PharmD, BCPS, and coauthors from the Brigham and Women's Hospital in Boston, MA, performed a meta-analysis that included patients being treated for stable angina with monotherapy. Findings from the study were presented at the ACC.17 Scientific Session.

The researchers conducted and extensive literature search (1945–2014) for randomized, controlled trials that compared anti-anginal drug efficacy for managing stable angina; studies were excluded if they had less than 100 patients, if patients were assessed for less than 7 days, or if exercise tolerance was not assessed.

Once exclusion criteria were applied, the researchers were left with 19 studies; total time to 1mm ST-segment depression and total time in exercise duration were used as primary endpoints. The anti-anginal agents evaluated included: amlodipine, atenolol, carvedilol, felodipine, isosorbide dinitrate, isosorbide mononitrate, ivabradine, metoprolol, nicorandil, nifedipine, ranolazine, and verapamil.

When assessing ranked probabilities, beta-blockers and calcium channel blockers were found to be the most efficacious, however there was no statistically significant difference between the agents. Drug associated most frequently with safety events included ivabradine, ranolazine, and metoprolol. The most common type of drug-related adverse effect was neurologic effects, with a total of 436 events reported.

Among all the different treatment options for stable angina, there were no major statistical differences in symptom reduction. Some of the study's limitations include non-homogenous trials in their standard of care due to large date range studied as well as a lack of reporting for adverse drug reactions that may be due to earlier publication dates and varying publication priorities. 

"Patient preference, cost, and comorbidities should be considered when initiating monotherapy for stable angina," concluded the authors.