Mavacamten treatment for obstructive hypertrophic cardiomyopathy a clinical trial

Stephen Heitner, Daniel Jacoby, Steven J. Lester, Anjali Owens, Andrew Wang, David Zhang, Joseph Lambing, June Lee, Marc Semigran, Amy J. Sehnert

    Research output: Contribution to journalArticle

    Abstract

    Background: Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying bio-mechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM). Objective: To characterize the effect of mavacamten on left ventricular outflow tract (LVOT) gradient. Design: Open-label, nonrandomized, phase 2 trial. (Clinical Trials.gov: NCT02842242) Setting: 5 academic centers. Participants: 21 symptomatic patients with oHCM. Intervention: Patients in cohort A received mavacamten, 10 to 20 mg/d, without background medications. Those in cohort B received mavacamten, 2 to 5 mg/d, with -blockers allowed. Measurements: The primary end point was change in postexercise LVOT gradient at 12 weeks. Secondary end points included changes in peak oxygen consumption (pVO2), resting and Valsalva LVOT gradients, left ventricular ejection fraction (LVEF), and numerical rating scale dyspnea score. Results: In cohort A, mavacamten reduced mean postexercise LVOT gradient from 103 mm Hg (SD, 50) at baseline to 19 mm Hg (SD, 13) at 12 weeks (mean change, 89.5 mm Hg [95% CI, 138.3 to 40.7 mm Hg]; P = 0.008). Resting LVEF was also reduced (mean change, 15% [CI, 23% to 6%]). Peak VO2 increased by a mean of 3.5 mL/kg/min (CI, 1.2 to 5.9 mL/kg/ min). In cohort B, the mean postexercise LVOT gradient decreased from 86 mm Hg (SD, 43) to 64 mm Hg (SD, 26) (mean change, 25.0 mm Hg [CI, 47.1 to 3.0 mm Hg]; P = 0.020), and mean change in resting LVEF was 6% (CI, 10% to 1%). Peak VO2 increased by a mean of 1.7 mL/kg/min (SD, 2.3) (CI, 0.03 to 3.3 mL/kg/min). Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80%), moderate (19%), and unrelated (79%) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation. Limitation: Small size; open-label design. Conclusion: Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.

    Original languageEnglish (US)
    Pages (from-to)741-748
    Number of pages8
    JournalAnnals of internal medicine
    Volume170
    Issue number11
    DOIs
    StatePublished - Jun 4 2019

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    Hypertrophic Cardiomyopathy
    Stroke Volume
    Clinical Trials
    Dyspnea
    Cardiac Myosins
    Ventricular Outflow Obstruction
    Therapeutics
    Oxygen Consumption
    Atrial Fibrillation
    Exercise

    ASJC Scopus subject areas

    • Internal Medicine

    Cite this

    Heitner, S., Jacoby, D., Lester, S. J., Owens, A., Wang, A., Zhang, D., ... Sehnert, A. J. (2019). Mavacamten treatment for obstructive hypertrophic cardiomyopathy a clinical trial. Annals of internal medicine, 170(11), 741-748. https://doi.org/10.7326/M18-3016

    Mavacamten treatment for obstructive hypertrophic cardiomyopathy a clinical trial. / Heitner, Stephen; Jacoby, Daniel; Lester, Steven J.; Owens, Anjali; Wang, Andrew; Zhang, David; Lambing, Joseph; Lee, June; Semigran, Marc; Sehnert, Amy J.

    In: Annals of internal medicine, Vol. 170, No. 11, 04.06.2019, p. 741-748.

    Research output: Contribution to journalArticle

    Heitner, S, Jacoby, D, Lester, SJ, Owens, A, Wang, A, Zhang, D, Lambing, J, Lee, J, Semigran, M & Sehnert, AJ 2019, 'Mavacamten treatment for obstructive hypertrophic cardiomyopathy a clinical trial', Annals of internal medicine, vol. 170, no. 11, pp. 741-748. https://doi.org/10.7326/M18-3016
    Heitner, Stephen ; Jacoby, Daniel ; Lester, Steven J. ; Owens, Anjali ; Wang, Andrew ; Zhang, David ; Lambing, Joseph ; Lee, June ; Semigran, Marc ; Sehnert, Amy J. / Mavacamten treatment for obstructive hypertrophic cardiomyopathy a clinical trial. In: Annals of internal medicine. 2019 ; Vol. 170, No. 11. pp. 741-748.
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    abstract = "Background: Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying bio-mechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM). Objective: To characterize the effect of mavacamten on left ventricular outflow tract (LVOT) gradient. Design: Open-label, nonrandomized, phase 2 trial. (Clinical Trials.gov: NCT02842242) Setting: 5 academic centers. Participants: 21 symptomatic patients with oHCM. Intervention: Patients in cohort A received mavacamten, 10 to 20 mg/d, without background medications. Those in cohort B received mavacamten, 2 to 5 mg/d, with -blockers allowed. Measurements: The primary end point was change in postexercise LVOT gradient at 12 weeks. Secondary end points included changes in peak oxygen consumption (pVO2), resting and Valsalva LVOT gradients, left ventricular ejection fraction (LVEF), and numerical rating scale dyspnea score. Results: In cohort A, mavacamten reduced mean postexercise LVOT gradient from 103 mm Hg (SD, 50) at baseline to 19 mm Hg (SD, 13) at 12 weeks (mean change, 89.5 mm Hg [95{\%} CI, 138.3 to 40.7 mm Hg]; P = 0.008). Resting LVEF was also reduced (mean change, 15{\%} [CI, 23{\%} to 6{\%}]). Peak VO2 increased by a mean of 3.5 mL/kg/min (CI, 1.2 to 5.9 mL/kg/ min). In cohort B, the mean postexercise LVOT gradient decreased from 86 mm Hg (SD, 43) to 64 mm Hg (SD, 26) (mean change, 25.0 mm Hg [CI, 47.1 to 3.0 mm Hg]; P = 0.020), and mean change in resting LVEF was 6{\%} (CI, 10{\%} to 1{\%}). Peak VO2 increased by a mean of 1.7 mL/kg/min (SD, 2.3) (CI, 0.03 to 3.3 mL/kg/min). Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80{\%}), moderate (19{\%}), and unrelated (79{\%}) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation. Limitation: Small size; open-label design. Conclusion: Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.",
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    AU - Heitner, Stephen

    AU - Jacoby, Daniel

    AU - Lester, Steven J.

    AU - Owens, Anjali

    AU - Wang, Andrew

    AU - Zhang, David

    AU - Lambing, Joseph

    AU - Lee, June

    AU - Semigran, Marc

    AU - Sehnert, Amy J.

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    N2 - Background: Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying bio-mechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM). Objective: To characterize the effect of mavacamten on left ventricular outflow tract (LVOT) gradient. Design: Open-label, nonrandomized, phase 2 trial. (Clinical Trials.gov: NCT02842242) Setting: 5 academic centers. Participants: 21 symptomatic patients with oHCM. Intervention: Patients in cohort A received mavacamten, 10 to 20 mg/d, without background medications. Those in cohort B received mavacamten, 2 to 5 mg/d, with -blockers allowed. Measurements: The primary end point was change in postexercise LVOT gradient at 12 weeks. Secondary end points included changes in peak oxygen consumption (pVO2), resting and Valsalva LVOT gradients, left ventricular ejection fraction (LVEF), and numerical rating scale dyspnea score. Results: In cohort A, mavacamten reduced mean postexercise LVOT gradient from 103 mm Hg (SD, 50) at baseline to 19 mm Hg (SD, 13) at 12 weeks (mean change, 89.5 mm Hg [95% CI, 138.3 to 40.7 mm Hg]; P = 0.008). Resting LVEF was also reduced (mean change, 15% [CI, 23% to 6%]). Peak VO2 increased by a mean of 3.5 mL/kg/min (CI, 1.2 to 5.9 mL/kg/ min). In cohort B, the mean postexercise LVOT gradient decreased from 86 mm Hg (SD, 43) to 64 mm Hg (SD, 26) (mean change, 25.0 mm Hg [CI, 47.1 to 3.0 mm Hg]; P = 0.020), and mean change in resting LVEF was 6% (CI, 10% to 1%). Peak VO2 increased by a mean of 1.7 mL/kg/min (SD, 2.3) (CI, 0.03 to 3.3 mL/kg/min). Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80%), moderate (19%), and unrelated (79%) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation. Limitation: Small size; open-label design. Conclusion: Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.

    AB - Background: Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying bio-mechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM). Objective: To characterize the effect of mavacamten on left ventricular outflow tract (LVOT) gradient. Design: Open-label, nonrandomized, phase 2 trial. (Clinical Trials.gov: NCT02842242) Setting: 5 academic centers. Participants: 21 symptomatic patients with oHCM. Intervention: Patients in cohort A received mavacamten, 10 to 20 mg/d, without background medications. Those in cohort B received mavacamten, 2 to 5 mg/d, with -blockers allowed. Measurements: The primary end point was change in postexercise LVOT gradient at 12 weeks. Secondary end points included changes in peak oxygen consumption (pVO2), resting and Valsalva LVOT gradients, left ventricular ejection fraction (LVEF), and numerical rating scale dyspnea score. Results: In cohort A, mavacamten reduced mean postexercise LVOT gradient from 103 mm Hg (SD, 50) at baseline to 19 mm Hg (SD, 13) at 12 weeks (mean change, 89.5 mm Hg [95% CI, 138.3 to 40.7 mm Hg]; P = 0.008). Resting LVEF was also reduced (mean change, 15% [CI, 23% to 6%]). Peak VO2 increased by a mean of 3.5 mL/kg/min (CI, 1.2 to 5.9 mL/kg/ min). In cohort B, the mean postexercise LVOT gradient decreased from 86 mm Hg (SD, 43) to 64 mm Hg (SD, 26) (mean change, 25.0 mm Hg [CI, 47.1 to 3.0 mm Hg]; P = 0.020), and mean change in resting LVEF was 6% (CI, 10% to 1%). Peak VO2 increased by a mean of 1.7 mL/kg/min (SD, 2.3) (CI, 0.03 to 3.3 mL/kg/min). Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80%), moderate (19%), and unrelated (79%) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation. Limitation: Small size; open-label design. Conclusion: Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.

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