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Ivabradine Shown An Effective Anti-Anginal Drug

Ivabradine, a new drug in a novel class of anti-anginals, has been found effective and safe over a three month trial, say researchers.

Clinicians at the Weill Medical College of Cornell University, New York, carried out the double blind, placebo controlled trial with ivabradine, a heart rate-lowering agent that acts specifically on the sinoatrial node.

Three hundred and sixty patients with at least a three month history of chronic stable angina were enrolled into the study. They were randomly assigned to receive ivabradine (2.5 mg, 5 mg, or 10 mg BID) or placebo for two weeks. The regimen was then followed by an open-label two or three month extension on ivabradine (10 mg BID), and a one week randomized withdrawal to ivabradine (10 mg BID) or placebo.

Measures of primary efficacy were changes in time to 1-mm ST-segment depression and time to limiting angina during bicycle exercise tolerance tests, which were carried out at the trough of drug activity.

Among the 257 patients in the per-protocol group, time to 1-mm ST-segment depression increased in the ivabradine 5 mg and 10 mg BID groups, and time to limiting angina increased in the 10 mg BID group.

There was deterioration in all parameters of the exercise tolerance test among patients who received placebo during randomized withdrawal. However, this effect was not seen among patients who were still receiving ivabradine.

Investigators did not see any rebound effects when the patients ended the trial treatments. They conclude that ivabradine produces dose-dependent improvements in exercise tolerance and time to development of ischaemia during exercise.
Circulation 2003 Feb 18;107:6:817-23. "Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial."

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