title: Comparative Effectiveness of Ranolazine Versus Traditional Therapies in Chronic Stable Angina Pectoris and Concomitant Diabetes Mellitus and Impact on Health Care Resource Utilization and Cardiac Interventions.
abstract: Comparative studies evaluating traditional versus newer antianginal (AA) medications in chronic stable angina pectoris (CSA) on cardiovascular (CV) outcomes and utilization are limited, particularly in patients with diabetes mellitus (DM). Claims data (2008 to 2012) were analyzed using a commercial database. Patients with CSA receiving a β blocker (BB), calcium channel blocker (CCB), long-acting nitrate (LAN), or ranolazine were identified and followed for 12 months after a change in AA therapy. Patients on traditional AA medications were required to have concurrent sublingual nitroglycerin. Therapy change was defined as adding or switching to another traditional AA medication or ranolazine to identify patients whose angina was inadequately controlled with previous therapy. Four groups were identified (BB, CCB, LAN, or ranolazine users) and matched on relevant characteristics. A DM subset was identified. Logistic regression compared revascularization at 30, 60, 90, 180, and 360 days. Negative binomial regression compared all-cause, CV-, and DM-related (in the DM cohort) health care utilization. A total of 8,008 patients were identified with 2,002 patients in each matched group. Majority were men (mean age 66 years). A subset of 3,724 patients with DM (BB, n = 933; CCB, n = 940; LAN, n = 937; and ranolazine, n = 914) resulted from this cohort. Compared to ranolazine in the overall cohort, traditional AA medication exhibited greater odds for revascularization and higher rates in all-cause outpatient, emergency room visits, inpatient length of stay, and CV-related emergency room visits. In the DM cohort, ranolazine demonstrated similar benefits over traditional AA medication. In conclusion, ranolazine use in patients with inadequately controlled chronic angina is associated with less revascularization and all-cause and CV-related health care utilization compared to traditional AA medication.
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, Colorado.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
authors.affiliation: College of Business and Economics, American University of Armenia, Yerevan, Armenia.
authors.forename: Vahram
authors.initials: V
authors.lastname: Ghushchyan
authors.affiliation: Peakstat Statistical Services, Evergreen, Colorado.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Read
authors.affiliation: Gilead Sciences, Foster City, California.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Hartsfield
authors.affiliation: Gilead Sciences, Foster City, California.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Koch
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, Colorado. Electronic address: Kavita.Nair@ucdenver.edu.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D060050:Angina, Stable / Q000150:complications* / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D002908:Chronic Disease; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000627:therapeutic use; D000069458:Ranolazine / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D014665:Vasodilator Agents; D000069458:Ranolazine; D005996:Nitroglycerin