[Clinico-economical aspects of application of trimetazidine MB in patients with chronic heart failure and cardiac rhythm disturbances].

AIM: To study clinical and pharmacoeconomical aspects of trimetazidine MD as a component of complex therapy of chronic heart failure (CHF) in patients with cardiac rhythm disturbances. MATERIAL AND METHODS: In 82 patients (67 men, 15 women, mean age 62.2+/-7.3 years) with II-III functional class (FC) of CHF we studied effect of addition of therapy with trimetazidine MB to standard therapy on CHF FC, parameters of Holter monitoring (HM) of ECG and treadmill test. In analysis of HM we considered number of isolated and paired ventricular extrasystoles (VE), episodes of nonsustained ventricular tachycardia (VT), duration of episodes of ST segment depression on 24-hour ECG. Pharmacoeconomical analysis of 2 therapy regimes was conducted by the method of calculation of cost/efficacy ratio for each parameter. Stabilization of state was achieved before study in all patients at the background of standard therapy with angiotensin converting enzyme inhibitors, cardiac glycosides, diuretics, beta-adrenoblockers. At the background of this therapy trimetazidine MB in the dose of 70 mg/day was added to 40 patients of group 1 while 42 patients of group 2 received standard therapy without trimetazidine MB. RESULTS: After 16 weeks of treatment CHF FC lowered 11% (<0.05) 10% (<0.05) in groups 1 and 2, respectively. According to data of HM numbers of VE decreased in group 1 by 57.6% (<0.05), in group 2 by 28.8% (<0.05), episodes of nonsustained VT--by 58.3% (<0,05) and 36.8% (<0.05), isolated VE--by 23.6% (>0.05) and 6.9% (>0.05), respectively. Duration of episodes of ST depression decreased 55.5% (<0.05) in group 1 and 23.3% (<0.05) in group 2. According to treadmill test maximal power of load in patients of group 1 rose 12.3% (<0.05), of group 2-6.7% (<0.05), total exercise duration rose 16.8% (<0.05) and 82% (<0.05), respectively. Cost/efficacy ratio expressed in roubles per 1% efficacy calculated for CHF FC was 2694 in group 1, 4095--in group 2; for maximal load power--2409 and 3667, respectively; for duration of episodes of ST segment depression--1665 and 1934, respectively; for dynamics of VE number--514 and 853, respectively. CONCLUSIONS: Supplementation of standard CHF therapy with therapy with metabolic cytoprotector trimetazidine MB allows to achieve more pronounced positive effect on CHF FC, exercise tolerance, and lowering of cardiac ectopic activity. Smallest cost efficacy ratio after addition of trimetazidine MB to standard therapy from pharmacoeconomical point of view evidence for advantages of this regime of therapy possessing smaller expenditures per unit of efficacy.

[Clinical-pharmacoeconomic aspects of trimetazidine modified release use in patients with ischemic heart disease undergoing coronary artery bypass grafting].

The aim of this study was to evaluate clinical and pharmacoeconomic effects of long-term use of trimetazidine MR in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting (CABG). Patients with IHD (n=306) were included in open, prospective, randomized clinical trial. One group (group 1, n=153) was pretreated with trimetazidine MR two weeks prior to CABG and continued to take trimetazidine MR for 3 years after the procedure. The other group without of trimetazidine MR (group 2, n=153) was the group of comparison. All patients received conventional therapy of IHD. Six hours after CABG serum creatinine kinase and creatinine-kinase MB were significantly lower in group 1 than in group 2. Rate of ischemic events was also lower in patients treated with trimetazidine MR. Long-term use of trimetazidine MR was characterized by improvement of left ventricular systolic function and exercise tolerance and associated with lower expenses for treatment. We concluded that trimetazidine MR appeared to reduce myocardial reperfusion injury after CABG in patients with IHD.

Trimetazidine: a second look. Still no efficacy in visual disorders.

(1) The current French indications for trimetazidine in loss of visual acuity and visual field disorders of presumed vascular origin cover a plethora of ophthalmological and neurological disorders. (2) The rare published clinical trials, all of which are flawed, fail to prove the efficacy of trimetazidine for these indications. (3) Data on adverse reactions to trimetazidine are inadequate. Rare but serious side effects cannot be ruled out. (4) Trimetazidine-based preparations are costly, especially given their doubtful benefit. (5) In practice, trimetazidine is no more than a placebo in its ophthalmological uses. In our opinion, the risk of side effects (albeit low) and the possibility that a trimetazidine prescription may reduce elderly patients' adherence to other, truly beneficial treatments, mean that prescribers should simply ignore these products.