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Randomized Controlled Trial
. 2024 Jul;121(8):e20230659.
doi: 10.36660/abc.20230659.

Allopurinol versus Trimetazidine for the Treatment of Angina: A Randomized Clinical Trial

[Article in Portuguese, English]
Tainá Viana  1 , Rodrigo Morel Vieira de Melo  1 , Diogo Freitas Cardoso Azevedo  2 , Clara Salles Figueiredo  1 , Gustavo Santana  1 , Luanna Mota Damasceno  2 , Luisa Latado  2 , Ludmila Tambuque  2 , Raissa Barreto  2 , Luiz Carlos Santana Passos  2
Affiliations
Randomized Controlled Trial

Allopurinol versus Trimetazidine for the Treatment of Angina: A Randomized Clinical Trial

[Article in Portuguese, English]
Tainá Viana et al. Arq Bras Cardiol. 2024 Jul.

Abstract
in English, Portuguese

Background: Recently, it was demonstrated that allopurinol, a xanthine oxidase inhibitor, has cardiovascular and anti-ischaemic properties and may be a metabolic antianginal agent option.Objective: The objective of this study was to evaluate the antianginal effect of allopurinol as a third drug for patients with stable coronary artery disease (CAD).

Methods: This was a randomized clinical trial between 2018 and 2020 including patients with CAD who maintained angina despite initial optimization with beta-blockers and calcium channel blockers. The individuals were randomized 1:1 to 300 mg of allopurinol twice daily or 35 mg of trimetazidine twice daily. The main outcome was the difference in the angina frequency domain of the Seattle Angina Questionnaire (SAQ-AF). A probability (p) value < 0.05 was considered statistically significant.

Results: A hundred and eight patients were included in the randomization phase, with 54 (50%) in the allopurinol group and 54 (50%) in the trimetazidine group. Six (5.6%) individuals, 3 from each group, were lost to follow-up for the primary outcome. In the allopurinol and trimetazidine groups, the median SAQ-AF scores were 50 (30.0 to 70.0) and 50 (21.3 to 78.3), respectively. In both groups, the SAQ-AF score improved, but the median of the difference compared to baseline was lower in the allopurinol group (10 [0 to 30] versus 20 [10 to 40]; p < 0.001), as was the mean of the difference in the total SAQ score (12.8 ± 17.8 versus 21.2 ± 15.9; p = 0.014).

Conclusion: Both allopurinol and trimetazidine improved the control of angina symptoms; however, trimetazidine presented a greater gain compared to baseline. Brazilian Registry of Clinical Trials - Registration Number RBR-5kh98y.

Fundamento: Recentemente, foi demonstrado que o alopurinol, um inibidor da xantina oxidase, possui propriedades cardiovasculares e anti-isquêmicas e pode ser uma opção de agente antianginoso metabólico.

Objetivo: O objetivo do presente estudo foi avaliar o efeito antianginoso do alopurinol como terceiro medicamento para pacientes com doença arterial coronariana (DAC) estável.

Métodos: Trata-se de um ensaio clínico randomizado entre 2018 e 2020 incluindo pacientes com DAC que mantiveram angina apesar da otimização inicial com betabloqueadores e bloqueadores dos canais de cálcio. Os indivíduos foram randomizados 1:1 para 300 mg de alopurinol 2 vezes ao dia ou 35 mg de trimetazidina 2 vezes ao dia. O desfecho principal foi a diferença no domínio da frequência da angina do Questionário de Angina de Seattle (QAS-FA). Foram considerados estatisticamente significativos valores de probabilidade (p) < 0,05.

Resultados: Foram incluídos 108 pacientes na fase de randomização, com 54 (50%) no grupo alopurinol e 54 (50%) no grupo trimetazidina. Seis (5,6%) indivíduos, 3 de cada grupo, foram perdidos no seguimento para o desfecho primário. Nos grupos de alopurinol e trimetazidina, as pontuações medianas do QAS-FA foram 50 (30,0 a 70,0) e 50 (21,3 a 78,3), respectivamente. Em ambos os grupos, a pontuação do QAS-FA melhorou, mas a mediana da diferença em relação à linha de base foi menor no grupo alopurinol (10 [0 a 30] versus 20 [10 a 40]; p < 0,001), assim como a média da diferença na pontuação total do QAS (12,8 ± 17,8 versus 21,2 ± 15,9; p = 0,014).

Conclusão: Tanto o alopurinol quanto a trimetazidina melhoraram o controle dos sintomas de angina; no entanto, a trimetazidina apresentou um ganho maior em relação à linha de base. Registro Brasileiro de Ensaios Clínicos – Número de Registro RBR-5kh98y.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura Central
Figura Central. : Alopurinol Versus Trimetazidina para o Tratamento da Angina: Ensaio Clínico Randomizado
Figura 1
Figura 1. – Fluxograma dos pacientes avaliados e incluídos no run-in, randomização e seguimento.
Figura 2
Figura 2. – Diferença nos domínios do Questionário de Angina de Seattle (QAS) em relação à linha de base nos grupos alopurinol e trimetazidina.
Central Illustration
Central Illustration. : Allopurinol versus Trimetazidine for the Treatment of Angina: A Randomized Clinical Trial
Figure 1
Figure 1. – Flowchart of the patients evaluated and included in the run-in, randomization, and follow-up.
Figure 2
Figure 2. – Difference in Seattle Angina Questionnaire (SAQ) domains compared to baseline in the allopurinol and trimetazidine groups.
See this image and copyright information in PMC

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