Clinical effect of various trimetazidine formulations in chronic coronary syndrome

Introduction: Trimetazidine is a metabolic agent of proven efficacy in the management of chronic coronary syndromes. According to guidelines, trimetazidine should be considered as a second-line treatment to reduce angina frequency and improve exercise tolerance in subjects whose symptoms are not adequately controlled by beta-blockers, calcium channel blockers and/or long-acting nitrates. Aim: This meta-analysis aimed to evaluate the efficacy of different doses (3 × 20 mg, 2 × 35 mg, 1 × 80 mg) of trimetazidine formulations in stable angina pectoris. Primary outcomes consisted of clinical parameters: numbers of weekly angina attacks and nitroglycerin usage. Method: Articles were collected from PubMed, Cochrane Library and Cochrane Central Register of Controlled Trials databases for the period from 1967 to 30 September 2019. Statistical analysis was performed by standard meta-analysis methods. Results: A total of 31 randomized controlled and observational trials, consisting of 9856 participants (mean age: 59.6 years, men: 61.6%) were included. Trimetazidine treatment, compared to placebo, reduced the number of weekly angina attacks (mean difference: –1.84, 95% CI: –2.39 to –1.30; p<0.0001) and reduced weekly nitroglycerin consumption (–1.65, 95% CI: –2.17 to –1.14; p<0.0001) in randomized trials. Trimetazidine treatment reduced the number of weekly angina attacks (–3.73, 95% CI: –4.53 to –2.92; p<0.0001) and nitroglycerin consumption (–3.23, 95% CI: –4.23 to –2.24; p<0.0001) in observational studies. No difference in angina reduction and nitroglycerin intake was observed between the three treatment doses (p = 0.57 and p = 0.48, respectively). Further results: the two primary variables decreased from visit to visit, higher enrollment angina rates and lower doses of trimetazidine were observed in shorter studies. Patients in shorter trials were younger than subjects in the longer ones. In shorter studies, the initial needs for nitroglycerin consumption and the following reduction were greater than those with longer duration. Conclusions: Regardless of dosage, trimetazidine has a favorable clinical effect in stable angina. New finding is that younger patients with more severe conditions show the most clinical benefit from treatment with trimetazidine. Orv Hetil. 2020; 161(16): 611–622.