Long-term safety of a novel antianginal armant in patients with severe chronic stable angina - The Ranolazine Open Label Experience (ROLE)

Objectives This report describes safety and tolerability data from 746 chronic angina patients treated in the ROLE (Ranolazine Open Label Experience) program. Background Ranolazine treats angina without depressing hemodynamic status. The long-term safety and tolerability of ranolazine have not been previously reported. Methods Patients with severe functional impairment from angina (mean Duke Treadmill Score [DTS] of -14.4) who completed 1 of 2 randomized treadmill trials entered the ROLE program. Ranolazine was titrated to optimal dosages between 500 and 1,000 mg twice daily. Physical examination, laboratory tests, and adverse event reporting were performed periodically. We conducted analyses to evaluate possible predictors of ranolazine intolerance, such as advanced age, diabetes, poor exercise tolerance, or history of myocardial infarctions or congestive heart failure (CHF). The ROLE program's mortality was compared against the DTS predictive model and other contemporary cohorts of high-risk CHO patients. Results Mean follow-up was 2.82 years. Two years after initial dosing, 571 patients (76.7%) remained on therapy and 72 patients (9.7%) discontinued ranolazine due to adverse events. Among 6 factors evaluated, only age -64 years predicted for higher withdrawal rates. Patients with a history of CHF had lower withdrawal rates. Mean QTc interval was prolonged by 2.4 ms. No treatment discontinuations occurred due to QTc prolongation, and no Torsades de Pointes was reported. Sixty-four deaths occurred during a total of 2,102 patient-years (3.0% annually) during the ROLE program. When extending observations to all patients exposed to ranolazine during the doubleblind trials (n = 972) preceding the ROLE program, annual mortality was 2.8% compared with > 5% as predicted by DTS. Conclusions Long-term therapy with ranolazine seems well tolerated in high-risk CHO patients. Survival analyses suggest that symptomatic improvements attributable to ranolazine are not offset by increased mortality.