Good! Is it the best???

The published article comparing ranolazine 500 mg BD and ivabradine 5 mg BD over 8 weeks has shown a reduction in the number of angina attacks per week from baseline angina frequency of 1.8 ± 0.2/week to complete absence of angina with 0 attacks per week. These findings with complete absence of angina after 2 months of treatment is quite surprising as the previous published studies with ranolazine have shown only reduction in the frequency of angina and not complete cessation of angina. Combination assessment of ranolazine in stable angina trial, done with ranolazine demonstrated a reduction in the mean number of weekly anginal attacks to 2.5 and 2.1 after 12 weeks of treatment at a dose of 750 mg BD and 1000 mg BD respectively.[3] Likewise, efficacy of ranolazine in chronic angina trial, showed a decline in the mean angina attacks from 5.5/week at baseline to 2.8/week in the ranolazine group at the end of 6‑week of treatment.[4] The TERISA trial done in 462 patients with chronic angina and diabetes mellitus, found the angina frequency had decreased from 6.6 (6.3‑7, confidence interval) to 3.8 (3.6‑4.1, confidence interval) per week in the ranolazine group (1000 mg BD for 8 weeks).[5] All the above mentioned studies also had shown a decrease in the use of sublingual nitrates per week in the presence of ranolazine. On the contrary, MARISA trial in 191 patients with angina, surprisingly found angina pectoris as an adverse event reported in 8 patients (5%) receiving ranolazine 500 mg BD.[6] Similarly in our study, which is yet to be published comparing ranolazine 500 mg BD and trimetazidine 35 mg BD given for 12 weeks in patients with chronic stable angina and diabetes mellitus, we came across patients developing angina resulting in either withdrawal from the study or increase in sublingual isosorbide di nitrate consumption per week. Hence we feel that in the present study, a mention about the change in adjuvant anti‑anginal drugs including nitrate consumption per week at the end of 8 weeks in both ranolazine and ivabradine groups could have helped in interpreting the efficacy of ranolazine in a better way. Moreover, as both primary and secondary outcomes of this study are based on questionnaire, a mention of the validity of the pre‑tested questionnaire or a table showing the questionnaire