Ivabradine

(Corlanor®)

Ivabradine

Drug updated on 12/11/2024

Dosage FormTablet (oral; 5 mg, 7.5 mg); Solution (oral; 5 mg/5 mL [1 mg/mL])
Drug ClassHyperpolarization-activated cyclic nucleotide-gated channel blockers
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated to reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with reduced left ventricular ejection fraction
  • Indicated for the treatment of stable symptomatic heart failure due to dilated cardiomyopathy in pediatric patients ages 6 months and older.

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Summary
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  • This summary is based on the review of 14 systematic review(s)/meta-analysis(es). [1-14]
  • Effectiveness in Dilated Cardiomyopathy (DCM) with Congestive Heart Failure: Ivabradine significantly reduced resting heart rate (mean difference (MD) = -15.95, 95% confidence interval (CI) [-19.97, -11.92]), improved left ventricular ejection fraction (LVEF), and reduced left ventricular end-systolic diameter (MD = -5.90, 95% CI [-9.36, -2.44]). It also improved quality of life (QoL) and New York Heart Association (NYHA) class without significantly affecting prognosis.
  • Heart Failure with Reduced Ejection Fraction (HFrEF): Ivabradine demonstrated effectiveness in reducing hospitalization for heart failure or cardiovascular death, improving ejection fraction, and enhancing health-related QoL with a similar risk of adverse events compared to background therapy alone.
  • Acute Coronary Syndrome (ACS): Ivabradine effectively controlled heart rate and improved left ventricular function in patients with ACS, though it did not significantly reduce short-term mortality.
  • Chronic Kidney Disease (CKD) Subgroup: In patients with CKD, ivabradine reduced the risk of cardiovascular death or hospitalization for heart failure compared to neurohormonal inhibition (hazard ratio (HR) 0.82, 95% credible interval (CrI) [0.69-0.98]), indicating benefit in this subgroup.
  • Increased Risk of Specific Adverse Events: Ivabradine was associated with an elevated risk of atrial fibrillation (relative risk (RR) = 1.19, 95% CI [1.04, 1.35]), bradycardia (RR = 3.95, 95% CI [1.88, 8.29]), and visual disturbances (RR = 4.76, 95% CI [3.03, 7.48]). Additionally, it showed a slight increase in non-serious adverse events (RR = 1.13, 95% CI [1.11, 1.16]).
  • Safety in Specific Populations: In patients with CKD, ivabradine demonstrated a safety profile comparable to neurohormonal inhibition, and in heart failure (HF) and ACS patients, ivabradine did not significantly impact the risk of major adverse cardiovascular events (MACE) or overall mortality.
  • Ivabradine demonstrated varied effectiveness across specific populations: it showed significant benefits in HFrEF and in patients with CKD by reducing cardiovascular death or hospitalization risk (HR 0.82, 95% CrI [0.69-0.98]), while benefits in heart failure with preserved ejection fraction (HFpEF) were less pronounced. In patients with ACS, ivabradine improved heart rate control and left ventricular function but did not significantly impact short-term mortality, and no significant quality of life improvements were observed in angina pectoris due to coronary artery disease (CAD).

Product Monograph / Prescribing Information

Document TitleYearSource
Corlanor (ivabradine) Prescribing Information.2021Amgen Inc., Thousand Oaks, CA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
The effect of ivabradine therapy on dilated cardiomyopathy patients with congestive heart failure: a systematic review and meta-analysis2023Frontiers in Cardiovascular Medicine
Ivabradine in patients with heart failure: a systematic literature review2023Journal of Market Access & Health Policy
Clinical use of ivabradine in the acute coronary syndrome: A systematic review and narrative synthesis of current evidence2022American Heart Journal Plus
Network meta-analysis of medical therapy efficacy in more than 90,000 patients with heart failure and reduced ejection fraction2022Journal of Internal Medicine
Efficacy of new medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis2022European Heart Journal
Ivabradine added to usual care in patients with heart failure: a systematic review with meta-analysis and trial sequential analysis2022BMJ Evidence-based Medicine
Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2021Cureus
Impact of ivabradine on the cardiac function of chronic heart failure reduced ejection fraction: Meta-analysis of randomized controlled trials2021Clinical Cardiology
Effect of ivabradine on exercise capacity in individuals with heart failure with preserved ejection fraction2021Heart Failure Reviews
Ivabradine as adjuvant treatment for chronic heart failure2020The Cochrane Database of Systematic Reviews
Effects of adding ivabradine to usual care in patients with angina pectoris: a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis2020Open Heart
Ivabradine for the Therapy of Chronic Stable Angina Pectoris: a Systematic Review and Meta-Analysis2020Korean Circulation Journal
Effect of ivabradine on major adverse cardiovascular events and mortality in critically ill patients: a systematic review and meta-analyses of randomised controlled trials with trial sequential analyses2020British Journal of Anaesthesia
New pharmacological treatments for heart failure with reduced ejection fraction (HFrEF): A Bayesian network meta-analysis2020Medicine

Clinical Practice Guidelines