Effect of ranolazine on glycaemia in adults with and without diabetes: A meta-analysis of randomised controlled trials

Background Ranolazine is an antianginal drug reported to have hypoglycaemic effects. Objectives To assess the effect of ranolazine versus placebo on glycaemic control for adults with and without diabetes. Methods A systematic search of seven databases was conducted to identify all randomised controlled trials that compared the effect of ranolazine versus placebo on haemoglobin A1c (HbA1c) and/or fasting plasma glucose (FPG) and/or incidence of hypoglycaemia. We used mean differences in HbA1c and FPG to express intervention effect estimates and analysed the data with random-effects model for meta-analyses using Revman 5.3. Results We identified seven trials including 6543 subjects to assess the effect of ranolazine on HbA1c and/or FPG. A separate trial that included 944 subjects was included to assess the effect of ranolazine on hypoglycaemia. The change in HbA1c for all patients was -0.36% (95% CI -0.57% to -0.15%; p=0.0004, I 2 =78%). In patients with diabetes, the change in HbA1c was -0.41% (95% CI -0.58% to -0.25%; p<0.00001, I 2 =65%). There was no significant difference in FPG between ranolazine and placebo groups (-2.58 mmol/L, 95% CI -7.02 to 1.85; p=0.25; I 2 =49%) or incidence of hypoglycaemia between ranolazine and placebo groups (OR 1.70, 95% CI 0.89 to 3.26; p=0.61, I 2 =0%). Conclusions Our meta-analytic findings support the fact that ranolazine improves HbA1c without increasing the risk of hypoglycaemia. It therefore has a potential of having an additional benefit of improving glycaemic control in patients with chronic stable angina and diabetes.