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Published on: June 8, 2019
Proangiogenic Growth Factor Therapy for the Treatment of Refractory Angina: A Meta-analysis
Deshan Weeraman1,2,3, Daniel A Jones1,2,3, Mohsin Hussain2,3
1Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
Background:
Refractory angina (RFA; limiting angina despite optimal medical therapy) is a growing, global problem, with limited treatment options. Therefore, we conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effect of proangiogenic growth factor therapy (in the form of vascular growth factors delivered either as recombinant proteins or gene therapy) in patients with RFA ineligible for revascularization.
Methods:
We performed a meta-analysis (PROSPERO: CRD42018107283) of RCTs as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A comprehensive search of the PubMed, CENTRAL, Embase, Cochrane, ClinicalTrials.gov and Google Scholar databases, as well as scientific session abstracts, were performed. The pooled outcomes included major adverse cardiac events (MACE), mortality, myocardial perfusion, and indices of angina severity (Canadian Cardiovascular Society angina class [CCS] and exercise tolerance). A prespecified subgroup analysis was performed for delivery method, vector, and protein type. The standardized mean difference (SMD) or odds ratio (OR) was calculated to assess relevant outcomes. We assessed heterogeneity using the χ2 and I2 tests.
Results:
We included 16 RCTs involving 1607 patients (1052 received proangiogenic growth factor therapy and 555 received a placebo or optimal medical therapy). Our analysis showed a significant decreased risk of MACE (OR, 0.72; 95% confidence interval [CI], 0.55-0.93) and significantly improved CCS class (SMD, -0.55; 95% CI, -1.10 to 0.00), but not mortality (OR, 0.66; 95% CI, 0.28-1.54) or exercise tolerance (SMD, 0.47; 95% CI, -0.14 to 1.09), in treated patients compared to those in the control group.
Conclusions:
Proangiogenic growth factor therapy is a promising treatment option for RFA, with beneficial effects seen on MACE and CCS class. The results of ongoing trials are needed before it can be considered for clinical practice.
Insights
Proangiogenic growth factor therapy shows promise for refractory angina (RFA), reducing major adverse cardiac events and improving angina class. Further trials are needed to confirm its clinical utility in RFA patients.
Area of Science:
- Cardiology
- Regenerative Medicine
- Clinical Trials
Background:
- Refractory angina (RFA) is a debilitating condition with limited treatment options.
- Proangiogenic growth factor therapy offers a potential new therapeutic avenue for RFA patients ineligible for revascularization.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) evaluating proangiogenic growth factor therapy in RFA.
- To assess the efficacy and safety of this therapy concerning major adverse cardiac events (MACE), mortality, myocardial perfusion, and angina severity.
Main Methods:
- A meta-analysis of 16 RCTs involving 1607 patients was conducted.
- Data on MACE, mortality, Canadian Cardiovascular Society (CCS) angina class, and exercise tolerance were pooled.
- Subgroup analyses considered delivery method, vector, and protein type.
Main Results:
- Proangiogenic growth factor therapy significantly reduced the risk of MACE (OR, 0.72; 95% CI, 0.55-0.93).
- A significant improvement in CCS angina class was observed (SMD, -0.55; 95% CI, -1.10 to 0.00).
- No significant effects on mortality or exercise tolerance were found.
Conclusions:
- Proangiogenic growth factor therapy demonstrates potential benefits for RFA patients, particularly in reducing MACE and improving angina symptoms.
- While promising, ongoing trials are necessary to establish its role in routine clinical practice.
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