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. 2017 Feb 8;2017(2):CD011747. doi: 10.1002/14651858.CD011747.pub2

Pepine 1999.

Methods Study design: cross‐over trial
Total study duration: 8 weeks
Duration of follow‐up: no follow‐up beyond treatment phase
Method of randomisation: not described
Method of concealment of allocation: not mentioned
Blinding: double‐blind (with "double dummy" technique)
Power calculation: not mentioned
Phases of the study: 2 (qualifying phase, treatment phase)
Number of patients randomised: 318
Exclusions post‐randomisation: 6 (not described)
Withdrawals (and reasons): premature withdrawals due to adverse events are declared to have been very similar for all treatments, but no details are provided
Participants Total number: 312
Country of enrolment: United States, Canada.
Setting/location: not specified
Diagnostic criteria (stable angina pectoris): chronic (≥ 3 months) stable angina pectoris that had responded to conventional anti‐anginal therapy
Comorbidities: none
Age (mean, range): 64.3 (33‐85) years
Gender (male %): 226 (72%)
Inclusion criteria:
  • Chronic (≥ 3 months) stable angina pectoris that had responded to conventional anti‐anginal therapy

  • Exercise‐induced ischaemia, defined as horizontal or down‐sloping ≥1 mm ST‐segment depression persisting in 3 consecutive beats


Exclusion criteria:
  • Left ventricular hypertrophy

  • Preexcitation

  • Conduction abnormalities

  • Pacemaker rhythm

  • Unstable angina

  • Myocardial infarction within the preceding 3 months

  • Heart failure (New York Heart Association class III or IV)

  • Uncorrected valvular

  • Congenital heart disease

  • Need for digoxin or long‐acting nitrates

  • Labile diabetes

  • Conditions that would confuse follow‐up evaluation

Interventions Number of intervention groups: 4
Concomitant medications: β‐blockers and/or calcium antagonists (minimum medication needed during qualifying phase)
Excluded medications: long‐acting nitrates
Placebo group
Intervention: placebo
Duration of intervention: 1 week (5 double‐blind treatment periods in an extended period Latin square design)
Ranolazine 400 mg bid group
Intervention: ranolazine IR 400 mg twice daily
Duration of intervention: 1 week (5 double‐blind treatment periods in an extended period Latin square design)
Ranolazine 267 mg tid group
Intervention: ranolazine IR 267 mg thrice daily
Duration of intervention: 1 week (5 double‐blind treatment periods in an extended period Latin square design)
Ranolazine 400 mg tid group
Intervention: ranolazine IR 400 mg thrice daily
Duration of intervention: 1 week (5 double‐blind treatment periods in an extended period Latin square design)
Outcomes Total number of outcomes:
  • According to study protocol: no published protocol; according to the "Methods" section: 9 (ETT time to onset of angina (peak and through), ETT duration of exercise (peak and through), ETT time to onset of ischaemic‐type ST‐segment depression (peak and through), haemodynamic, laboratory, adverse events)

  • Reported: 9


Adverse events incidence
Outcome definition: number of patients experiencing an adverse event
Method and unit of measurement: percentage
Time points reported: 1 week
RESULTS
Adverse events incidence
Sample size: 312 (intention‐to‐treat)
Missing participants: 6
Summary data: it is stated that adverse events rates were similar for all ranolazine and placebo regimens and approximately 25%, but data for each group is not reported. It is stated that only minor gastrointestinal complaints tended to occur more often with ranolazine (6.6% to 10.7%) than with placebo (3,2%).
Subgroup analyses: not performed
Notes Relevant observations for the data provided before: "all patients" (intention‐to‐treat) (N = 312) and per‐protocol (N = 260) analysis were performed for ETT variables
Source of funding: in part by a grant from Syntex Research
Notable conflicts of interest: not stated
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Randomisation is stated but no described
Allocation concealment (selection bias) Unclear risk Not mentioned
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Study is declared to be double‐blinded, but no description is provided
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Study is declared to be double‐blinded, but no description is provided
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Exclusions and withdrawals are reported, but no reasons or explanations are provided
Selective reporting (reporting bias) Unclear risk There is no published protocol. Results for all the outcomes stated in the "Methods" section of the paper are reported
Other bias Unclear risk The study was supported in part by a grant from Syntex Research. The authors did not stated any conflicts of interest.