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

Sandhiya 2015.

Methods Study design: parallel‐group trial
Total study duration: from 1 January 2012 to 11 April 2013
Duration of follow‐up: no follow‐up beyond treatment phase
Method of randomisation: not described, performed in a 1:1 ratio
Method of concealment of allocation: drugs distributed using sequentially numbered opaque sealed envelopes
Blinding: not mentioned
Power calculation: not mentioned
Phases of the study: 1 (treatment phase)
Number of patients randomised: 47 (24/23 for trimetazidine/ranolazine group)
Exclusions post‐randomisation: not reported
Withdrawals (and reasons): not reported
Participants Total number: 40
Country of enrolment: Greece
Setting/location: outpatient
Diagnostic criteria (stable angina pectoris): history of exertional angina and CAD documented by coronary angiography (macrovascular angina)
Comorbidities: diabetes mellitus
Age (mean): 57.4 ± 9.1 / 58 ± 8.1 years for trimetazidine/ranolazine group
Gender (male %): 83% (87.5/78.3 for trimetazidine/ranolazine group)
Inclusion criteria:
  • Aged ≥ 18 years

  • Diagnosis of CAD: documented by coronary angiography/minimum three months history of exertional angina

  • Diagnosis of diabetes mellitus with HbA1c>7%


Exclusion criteria:
  • History of myocardial infarction in the previous three months

  • Heart failure

  • Valvular heart diseases

  • Alcoholic cardiomyopathy

  • Renal failure

  • Chronic lung diseases

  • Hepatic failure

  • Baseline ECG abnormalities

  • Hyperthyroidism

  • Secondary causes of angina

  • Pregnancy/absence of contraceptive use in women of childbearing age/lactating mothers

  • Patients on P‐glycoprotein inhibitors, drugs known to prolong QT interval, CYP3A4 inhibitors, CYP3A4 inducers, pacemaker

  • Patients participating in other clinical trials or those who participated in any clinical trial within the last three months

Interventions Number of intervention groups: 2
Concomitant medications: statins
Excluded medications: those mentioned in exclusion criteria
Trimetazidine group
  • Intervention: trimetazidine 35 mg twice daily

  • Duration of intervention: 3 months


Ranolazine group
  • Intervention: ranolazine (type of formulation not specified) 500 mg twice daily

  • Duration of intervention: 3 months

Outcomes Total number of outcomes: 1
  • According to study protocol: no published protocol; according to the "Materials and Methods" section: 5 (angina episodes frequency, adverse events, biochemical diabetes assessment, QTc interval, haemodynamic parameters)

  • Reported: 6 (including sublingual nitrate consumption frequency)


Angina episodes frequency
  • Outcome definition: average angina attacks per week

  • Method and unit of measurement: number per week

  • Time points reported: 12 weeks


RESULTS
Angina episodes frequency
  • Sample size: 47 (intention‐to‐treat analysis)

  • Missing participants: none

  • Summary data: mean (SD) 1.4(2.2) / 1.2(1.7) for trimetazidine/ranolazine group (baseline values are also reported)

  • Subgroup analyses: not performed


Adverse events
The adverse events reported for the ranolazine group included angina, constipation, postural hypotension, headache, dizziness, nausea and weakness; for the trimetazidine group were constipation, weakness, palpitations, angina, dizziness, nausea, dyspepsia, headache, gastric discomfort and joint pain.
Notes Relevant observations for the data provided before: none
Source of funding: no external source of funding
Notable conflicts of interest: the authors declare that they have no conflict of interest
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Randomisation is stated but described only as "in a 1:1 ratio"
Allocation concealment (selection bias) Low risk Study drugs were provided in sequentially numbered opaque sealed envelopes
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Study declared to be double‐blinded, but no description is provided. However, it can be presumed that participants and personnel were blinded since drugs were provided in sealed envelopes
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Study declared to be double‐blinded, but no description is provided
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No exclusion or withdrawal is reported, we assume that all patients completed the study
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 Low risk The authors declare that the study was not supported by external source of funding. Also, they declared that they had no conflict of interest.