Efficacy and safety of fasudil in patients with stable angina: a double-blind, placebo-controlled, phase 2 trial.
OBJECTIVE
This study sought to evaluate the efficacy and safety of fasudil, an orally available rho kinase inhibitor, in patients with stable angina.


BACKGROUND
Several small, non-placebo-controlled trials suggest that fasudil reduces myocardial ischemia in patients with stable or vasospastic angina.


METHODS
In a multicenter, double-blind, placebo-controlled, randomized trial, the efficacy and safety of fasudil were evaluated in stable angina patients. Of the 206 patients screened, 84 patients with reproducible exercise times were randomized 1:1 to fasudil or placebo. Nitroglycerin as needed and a beta- or calcium-channel blocker were allowed. Fasudil or matching placebo was force-titrated from 20 mg three times daily to 80 mg twice daily with 20 mg twice-daily increments every two weeks. Symptom-limited exercise testing was performed after two, four, six, and eight weeks of treatment.


RESULTS
At peak, exercise duration was significantly improved at all visits in both groups, although exercise duration was numerically greater in patients receiving fasudil versus those receiving placebo. Time to > or =1 mm ST-segment depression was increased with fasudil at both peak and trough compared with placebo (172.1 s vs. 44.0 s, p = 0.001, and 92.8 s vs. 26.4 s, p = 0.02, respectively). Fasudil improved Seattle Angina Questionnaire scores. No significant differences in Canadian Cardiovascular Society class, time to angina, or frequency of angina or nitroglycerin use were noted between groups. Fasudil did not affect heart rate or blood pressure, and was well tolerated.


CONCLUSIONS
Fasudil up to 80 mg three times daily significantly increased the ischemic threshold of angina patients during exercise with a trend toward increased exercise duration. Further investigation of fasudil doses >80 mg three times daily is indicated.
Vicari
Ralph M
RM
MIMA Century Research Associates, Melbourne, Florida 32901, USA. ralph.vicari@mima.com
Chaitman
Bernard
B
Keefe
Deborah
D
Smith
William B
WB
Chrysant
Steven G
SG
Tonkon
Melvin J
MJ
Bittar
Neville
N
Weiss
Robert J
RJ
Morales-Ballejo
Hugo
H
Thadani
Udho
U
D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine; C049347:fasudil