title: Efficacy comparison of trimetazidine with therapeutic alternatives in stable angina pectoris: a network meta-analysis.
abstract: OBJECTIVE
  To compare the antianginal efficacy of trimetazidine with that of other agents with no influence on heart rate.
  
  
  RESULTS
  Medline and Embase databases were searched for blinded, randomized, controlled trials assessing the effects of non-heart-rate-lowering antianginal treatments on exercise tolerance and/or clinical criteria in stable angina patients. All relevant trimetazidine trials including the VASCO trial, the results of which are published herein, were included. A Bayesian network meta-analysis on the summary data was performed. Comparator antianginal agents were considered as a group and in agent/class subgroups. Trials involving β-blockers, non-dihydropyridine calcium channel blockers, and ivabradine were excluded. 218 trials totaling 19,028 patients were included in at least 1 network analysis. Effects of trimetazidine were statistically significant compared with placebo for exercise tolerance and clinical criteria. Transposition of results into seconds for clinical interpretation of exercise tolerance parameters showed a mean improvement of +46 s (95% credibility interval: 28; 66) for total exercise duration, +55 s (35; 77) for 1-mm ST segment depression (T1), and +54 s (24; 84) for time to onset of angina, in favor of trimetazidine. Differences between trimetazidine and active comparators were not significant when exercise tolerance and clinical criteria were analyzed, with +7 s (-12; 28) for total exercise duration, -1 s (-23; 22) for T1, +8 s (-22; 40) for time to onset of angina, and -0.28 (-1.17; 0.64) attacks per week for trimetazidine compared with antianginal agents as a group.
  
  
  CONCLUSIONS
  Trimetazidine efficacy was comparable to that of other non-heart-rate-lowering antianginal treatments in patients with stable angina pectoris.
authors: Department of Coronary Artery Disease and Acute Cardiac Care, Hôpital Européen Georges Pompidou, Paris, France. nicolas.danchin@egp.aphp.fr
authors: Nicolas
authors: N
authors: Danchin
authors: Mario
authors: M
authors: Marzilli
authors: Alexander
authors: A
authors: Parkhomenko
authors: Jorge P
authors: JP
authors: Ribeiro
mesh_terms: D006801:Humans; D060050:Angina, Stable / Q000188:drug therapy; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004338:Drug Combinations; D017079:Exercise Tolerance / Q000187:drug effects; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D016896:Treatment Outcome; D014292:Trimetazidine / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D003692:Delayed-Action Preparations; D004338:Drug Combinations; D014292:Trimetazidine; D014665:Vasodilator Agents