Ranolazine (Roche Bioscience).

Ranolazine is a metabolic modulator that is being developed by CV Therapeutics (CVT), under license from Roche (formerly Syntex), as a potential treatment for angina. In August 1999, the first of two pivotal phase III clinical trials in patients with stable angina was completed. In August 1999, CVT announced initial results from this trial, designated the MARISA trial, of ranolazine in patients with stable angina. At each of the three doses studied, ranolazine significantly increased patients' treadmill exercise duration compared to placebo, the primary endpoint for this trial. MARISA (monotherapy assessment of ranolazine in stable angina) was a randomized, double-blind, placebo-controlled trial of a sustained release formulation of ranolazine used in 175 patients who were not receiving other anti-anginal drugs. Compared to placebo, ranolazine taken bid at doses of 500, 1000 or 1500 mg significantly increased exercise duration at trough plasma concentrations, which occur at about 12 h after the previous dose. In addition, two key secondary endpoints, exercise time to onset of angina and exercise time to the electrocardiographic appearance of ischemia were also significantly increased by ranolazine compared to placebo at all three doses. The company plans on presenting additional data at a major medical conference, including safety and tolerability data, which are still under analysis. In July 1999 CVT initiated its second phase III trial. The CARISA trial (combination assessment of ranolazine in stable angina) is a randomized, double-blind, placebo-controlled trial of ranolazine used in combination with other anti-anginal drugs, in approximately 450 patients. The primary endpoint for this trial, duration of exercise on a treadmill, is identical to that used in phase II clinical trials. The CARISA trial, along with the pivotal phase III MARISA trial which completed treatment in June 1999, is expected to form the basis of the company's NDA submission to the FDA. In June 1999, results of a randomized, double-blind, placebo-controlled phase II study of ranolazine in chronic stable angina pectoris were published in the July 1, 1999 issue of the American Journal of Cardiology. The study of 312 patients demonstrated that ranolazine may increase exercise time in chronic stable angina patients. The results also indicate that there may be no change in heart rate or blood pressure among any of the ranolazine dosing regimens. In January 1999, CVT received regulatory clearance in Canada, the Czech Republic and Poland and initiated its first pivotal phase III trial for ranolazine in these countries. These new clinical trial centers complement the US centers enrolling American patients. The compound allows maintenance of energy output by muscle cells by improving oxygen metabolism to make the heart pump more efficiently. Ranolazine may be especially useful in angina patients in whom other therapies are ineffective. Clinical studies suggest that ranolazine lowers the heart's demand for oxygen, by increasing its ability to use carbohydrate rather than fat as a fuel. This is thought to be due to activation of pyruvate dehydrogenase, and also by modulating the activities of L-type calcium channels. This is achieved without reducing heart rate or blood pressure, or impairing pumping ability. In August 1998, CVT signed an agreement with Catalytica Pharmaceuticals, which will manufacture specified quantities of ranolazine for use in clinical trials.