Cost-effectiveness of sustained-release isosorbide mononitrate capsules for coronary heart disease: A network meta-analysis

doi:10.5246/jcps.2025.04.028

Abstract

Abstract:

Different dosage forms can significantly impact pharmacokinetics in vivo, leading to varied effects and potential adverse reactions. This study aimed to evaluate the efficacy, safety, and cost-effectiveness of isosorbide mononitrate sustained-release capsules (IMSRC) combined with conventional treatments, compared to isosorbide mononitrate tablets (IMT) combined with conventional treatments, for managing angina pectoris in patients with coronary heart diseases. A network meta-analysis (NMA) was conducted to assess the efficacy and safety of IMSRC and IMT. Relevant literature was sourced from databases, including PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, CNKI, Wanfang, and VIP, covering publications up to July 2023. The cost-effectiveness analysis (CEA) was performed from the perspective of China’s healthcare system, utilizing inputs derived from the NMA. The analysis included 15 studies. The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments. However, both combinations were more effective than conventional treatments without isosorbide mononitrate. No differences in safety were observed among the three groups. The surface under the cumulative ranking (SUCRA) of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris, whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT. The incidence of adverse events was ranked as IMT > conventional preparation > IMSRC. The CEA results highlighted that the incremental cost-effectiveness ratios (ICERs) for the markedly effective and total effective rates of angina pectoris were –133.41 and –260.20, respectively. The ICERs for ECG effective rates were –83.34 and –234.24, respectively. In conclusion, while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety, IMSRC proved to be more economical.

Key words: Isosorbide mononitrate sustained-release capsules, Network meta-analysis, Cost-effectiveness, Coronary heart disease

Supporting: /attached/file/20250504/20250504143422_81.pdf

Hui Zhang, Danxia Luo, Xuelan Zhou, Xiaofang Zeng, Ran Xiong, Yeyou Xu. Cost-effectiveness of sustained-release isosorbide mononitrate capsules for coronary heart disease: A network meta-analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(4): 370-384.

Figures/Tables 8

Table 1. biaoti

Table 2. Baseline results.

References 43

[1]	National Center for Cardiovascular Diseases. China Cardiovascular Health and Disease Report 2022. Beijing: China Union Medical University Press. 2023.
[2]	National Health Commission. China Health Statistics Yearbook: 2021. China Union Medical University Press. 2021.
[3]	Ding, J.M.; Zhang, X.Z.; Hu, X.J.; Chen, H.L.; Yu, M. Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi’an, China: a retrospective study. Medicine. 2017, 96, e9341.
[4]	Chen, W.W.; Gao, R.L.; Liu, L.S.; Zhu, M.L.; Wang, W.; Wang, Y.J.; Wu, Z.S.; Li, H.J.; Gu, D.F.; Yang, Y.J.; Zheng, Z.; Jiang, L.X.; Hu, S.S. China cardiovascular diseases report 2015: a summary. J. Geriatr. Cardiol. 2017, 14, 1–10.
[5]	Gheorghe, A.; Griffiths, U.; Murphy, A.; Legido-Quigley, H.; Lamptey, P.; Perel, P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health 2018, 18, 975.
[6]	Parker, J.D.; Parker, J.O. Nitrate therapy for stable angina pectoris. N. Engl. J. Med. 1998, 338, 520–531.
[7]	Ignarro, L.J.; Lippton, H.; Edwards, J.C.; Baricos, W.H.; Hyman, A.L.; Kadowitz, P.J.; Gruetter, C.A. Mechanism of vascular smooth muscle relaxation by organic nitrates, nitrites, nitroprusside and nitric oxide: evidence for the involvement of S-nitrosothiols as active intermediates. J. Pharmacol. Exp. Ther. 1981, 218, 739–749.
[8]	Kukovetz, W.R.; Holzmann, S. Mechanism of nitrate-induced vasodilation and tolerance. Z. Kardiol. 1983, 72, 14–19.
[9]	Murad, F. Cyclic guanosine monophosphate as a mediator of vasodilation. J. Clin. Invest. 1986, 78, 1–5.
[10]	Thadani, U. Oral nitrates: more than symptomatic therapy in coronary artery disease? Cardiovasc. Drugs Ther. 1997, 11, 213–218.
[11]	Silber, S. Nitrates: why and how should they be used today? Current status of the clinical usefulness of nitroglycerin, isosorbidedinitrate and isosorbide-5-mononitrate. Eur. J. Clin. Pharmacol. 1990, 38, S35–S51.
[12]	Thadani, U. Nitrate tolerance, rebound, and their clinical relevance in stable angina pectoris, unstable angina, and heart failure. Cardiovasc. Drugs Ther. 1997, 10, 735–742.
[13]	Waller, D.G. Optimal nitrate therapy with a once-daily sustained-release formulation of isosorbide mononitrate. J. Cardiovasc. Pharmacol. 1999, 34, S21–S31.
[14]	Schindler, T.H.; Fearon, W.F.; Pelletier-Galarneau, M.; Ambrosio, G.; Sechtem, U.; Ruddy, T.D.; Patel, K.K.; Bhatt, D.L.; Bateman, T.M.; Gewirtz, H.; Shirani, J.; Knuuti, J.; Gropler, R.J.; Chareonthaitawee, P.; Slart, R.H.J.A.; Windecker, S.; Kaufmann, P.A.; Abraham, M.R.; Taqueti, V.R.; Ford, T.J.; Camici, P.G.; Schelbert, H.R.; Dilsizian, V. Myocardial perfusion PET for the detection and reporting of coronary microvascular dysfunction A JACC: cardiovascular imaging expert panel statement. JACC Cardiovasc. Imag. 2023, 16, 536–548.
[15]	Peng, C.Y; Chen, J.; Li, S.N; Li, J.H; Peng, L.B. Evidence-based pharmacoeconomic evaluation of palbociclib in combination with letrozole versus docetaxel in combination with epirubicin in the first-line treatment of advanced breast cancer with epirubicin. J. Chin. Pharm. Sci. 2023, 32, 214–222.
[16]	Han, S.; Shi, L.W. Economic evaluation of soft silicon foam dressings versus sterile gauze for the treatment of pressure ulcers in China. J. Chin. Pharm. Sci. 2013, 22, 456–460.
[17]	Clinical Pharmacology Base of Cardiovascular system of the Ministry of Health. Guiding principles for clinical research of cardiovascular system drugs. Chin. J. Clin. Pharmacol. 2018, 4, 245–255.
[18]	Cumpston, M.; Li, T.J.; Page, M.J.; Chandler, J.; Welch, V.A.; Higgins, J.P.; Thomas, J. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst. Rev. 2019, 10, ED000142.
[19]	Lu, J.S; Xie, P.S; Wang, R.Z; Zhang, H.S. Clinical observation of domestic isosorbidemononitrate in the treatment of 100 cases of angina pectoris of coronary heart disease. J. Pharm. Res. 1998, 02, 52–53.
[20]	He, M. Effect analysis of isosorbidemononitrate in the treatment of 45 cases of angina pectoris. Modern Diagn. Treat. 2012, 23, 2.
[21]	Meng, Y. Efficacy of isosorbidemononitrate sustained-release capsules in treatment of angina pectoris. Know. Prevent. Treat. Cardiovasc. Dis. Acad. Edit. 2014, 11, 3.
[22]	Weng, J.L. Observation on the efficacy, safety and clinical compliance of isosorbidemononitrate sustained release capsule in the treatment of angina pectoris. J. Guizhou Univ. Tradit. Chin. Med. 2014, 36, 62–64.
[23]	Yan, X. Clinical observation on 39 cases of angina pectoris treated with isosorbidemononitrate sustained release capsule. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2014, 23, 103.
[24]	Cai, Q.L. Observation on the effect of isosorbidemononitrate in the treatment of coronary heart disease and cardiac dysfunction. Henan Med. Res. 2015, 24, 121.
[25]	Luo, X.Y. Clinical observation of isosorbidemononitrate sustained release capsule in the treatment of angina pectoris. Journal of China Prescription Drug. 2015, 13, 63.
[26]	Zhu, Y.F. Clinical Diagnosis and Treatment of Coronary Heart Disease With angina pectoris. China Continuing Medical Education. 2015, 7, 115–116.
[27]	Guo, C. Clinical effect of isosorbidemononitrate tablets in the treatment of angina pectoris. World’s latest Med. Inform. Abstr. 2016, 93, 2.
[28]	Shi, Q.T. Observation on the efficacy of isosorbide mononitrate capsule in the treatment of angina pectoris of coronary heart disease. Electron. J. Cardiovasc. Dis. Integr. Tradit. Chin. West. Med. 2016, 4, 58–59.
[29]	Wang, T. Clinical evaluation of isosorbidemononitrate capsule in the treatment of angina pectoris of coronary heart disease. World Biotechnol. 2016, 1, 1.
[30]	Geng, Z.Y. Clinical value of isosorbide mononitrate sustained release capsule in the treatment of angina pectoris. Electronic J. Clin. Med. Literat. 2017, 4, 2709.
[31]	Ma, D.L. Clinical observation of Isosorbide Mononitrate Sustained Release Tablets in treatment of angina pectoris of coronary heart disease of 30 patients. World’s latest Med. Inform. Abst. 2005.
[32]	Gao, Y. Clinical observation of isosorbidemononitrate sustained release capsule in the treatment of angina pectoris. J. Aero. Med. 2019, 30, 845–846.
[33]	Meng, L; Wang, J; Han, J. To study the clinical efficacy and adverse reactions of isosorbidemononitrate capsule in the treatment of angina pectoris of coronary heart disease. World Dia. 2021, 018, 85.
[34]	Wu, Y.H.; Liu, Y.P.; Pang, J.Z. Clinical observation of isosorbidemononitrate combined with Kudiezi in the treatment of 230 cases of angina pectoris of coronary heart disease. Shandong Med. J. 2008, 48, 64–65.
[35]	Zhao, J; Zhang, L; Ren, H. Clinical observation of combination of traditional Chinese and western medicine in the treatment of coronary heart disease and angina pectoris. China Med. Guide. 2013, 15, 1751–1752.
[36]	Xu, J; Chang, X; Ding, R. Observation on the efficacy of integrated traditional Chinese and western medicine in the treatment of 60 cases of coronary heart disease and angina pectoris. Chin. J. Biochem. Drugs. 2014, 34, 111–113.
[37]	Waller, D.G. Optimal nitrate therapy with a once-daily sustained-release formulation of isosorbide mononitrate. J. Cardiovasc. Pharmacol. 1999, 34, S21–S27.
[38]	Willich, S.N. European survey on circadian variation of angina pectoris (ESCVA): design and preliminary results. J. Cardiovasc. Pharmacol. 1999, 34, S9–S13.
[39]	Prakash, A.; Markham, A. Long-acting isosorbide mononitrate. Drugs. 1999, 57, 93–99.
[40]	He, X; Wu, J; Zhang, C. 5-isosorbide mononitrate sustained release agent in the treatment of angina pectoris. Lingnan J. Cardiovasc. Dis. 1999, 5, 214.
[41]	Zhu, Z; Jiang, L. Clinical therapeutic advantages of long-acting Isosorbide-5-mononitrate sustained-release capsules and their use in asymptomatic myocardial ischemia. North. Pharm. 2013, 10, 2.
[42]	Meng, X; Yan, X; Li, D. Circadian rhythm and countermeasures of acute cardiac events. China J. Circulat. 2003, 18, 472–473.
[43]	Chen, M. Observation on efficacy and clinical compliance of isosorbidemononitrate sustained-release capsule in the treatment of angina pectoris. Fam. Psychiat. 2015, 11, 2.