Early combination therapy with trimetazidine rapidly improves symptoms and quality of life in patients recently diagnosed with stable angina: The COMBINE angina study.

BACKGROUND

This real-world study evaluated the effectiveness and safety of an early combination of trimetazidine plus a calcium channel blocker (CCB) or β-blocker in patients with stable angina pectoris.

METHODS

COMBINE Angina (NCT06298045) was a prospective observational study across five countries (Brazil, Egypt, India, Malaysia, Romania). Eligible patients were recently diagnosed with stable angina and remained symptomatic after 2-4 weeks of treatment with a first-line CCB or β-blocker. Patients initiated add-on trimetazidine and were followed over 4 months. The primary endpoint was the 7-item Seattle Angina Questionnaire (SAQ-7) summary score at 4 months. Secondary endpoints included SAQ-7 domain scores, Canadian Cardiovascular Society (CCS) angina severity class, frequency of angina attacks and short-acting nitrate use, patient- and physician-reported treatment satisfaction, and adverse events (AEs).

RESULTS

The per-protocol population comprised 578 patients. Over 4 months, the mean ± standard deviation SAQ-7 summary score improved from 39.2 ± 13.7 to 78.4 ± 16.3 (out of 100; P < 0.0001). Significant improvements in all SAQ-7 domain scores, CCS class, and the frequency of angina attacks and short-acting nitrate use were also observed (all P < 0.0001 at each time point vs. baseline). Moreover, 85 % of patients remained on the same trimetazidine combination therapy, ≥90 % of patients and physicians were satisfied with treatment, and physicians for most patients (92 %) indicated that they would continue trimetazidine combination therapy beyond study end. A low incidence of treatment-related AEs (0.7 %) was reported.

CONCLUSIONS

Early trimetazidine combination therapy can rapidly reduce the burden of angina in patients inadequately controlled by a first-line CCB or β-blocker.

TAKE-HOME MESSAGE: The real-world COMBINE Angina study showed that early initiation of trimetazidine combination therapy can rapidly reduce the burden of stable angina in patients not promptly controlled by a first-line calcium channel blocker or β-blocker.