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Felker GM, Solomon SD, Claggett B, et al. Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial. JAMA Cardiol. 2021;doi: 10.1001/jamacardio.2021.4027.
Felker, G. M., Solomon, S. D., Claggett, B., Diaz, R., McMurray, J. J. V., Metra, M., Anand, I., Crespo-Leiro, M. G., Dahlström, U., Goncalvesova, E., Howlett, J. G., MacDonald, P., Parkhomenko, A., Tomcsányi, J., Abbasi, S. A., Heitner, S. B., Hucko, T., Kupfer, S., Malik, F. I., & Teerlink, J. R. (2021). Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial. JAMA cardiology, . https://doi.org/10.1001/jamacardio.2021.4027
Felker, G Michael, et al. "Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial." JAMA cardiology vol. (2021). doi: https://doi.org/10.1001/jamacardio.2021.4027
Felker GM, Solomon SD, Claggett B, Diaz R, McMurray JJV, Metra M, Anand I, Crespo-Leiro MG, Dahlström U, Goncalvesova E, Howlett JG, MacDonald P, Parkhomenko A, Tomcsányi J, Abbasi SA, Heitner SB, Hucko T, Kupfer S, Malik FI, Teerlink JR. Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial. JAMA Cardiol. 2021 Oct 13; doi: 10.1001/jamacardio.2021.4027. Epub 2021 Oct 13. PMID: 34643642; PMCID: PMC8515258.
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JAMA Cardiol. 2021 Oct 13; doi: 10.1001/jamacardio.2021.4027. Epub 2021 Oct 13.

Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial.

JAMA cardiology

G Michael Felker, Scott D Solomon, Brian Claggett, Rafael Diaz, John J V McMurray, Marco Metra, Inder Anand, Marisa G Crespo-Leiro, Ulf Dahlström, Eva Goncalvesova, Jonathan G Howlett, Peter MacDonald, Alexander Parkhomenko, János Tomcsányi, Siddique A Abbasi, Stephen B Heitner, Thomas Hucko, Stuart Kupfer, Fady I Malik, John R Teerlink

Affiliations

  1. Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
  2. Duke Clinical Research Institute, Durham, North Carolina.
  3. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  4. Instituto Cardiovascular de Rosario, Estudios Clínicos Latino América, Rosario, Argentina.
  5. Cardiovascular Research Centre, British Heart Foundation, Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  6. Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy.
  7. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis.
  8. Division of Cardiology, Universidad da Coruña, A Coruña, Galicia, Spain.
  9. Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
  10. Department of Cardiology, Odd. Srdcovehozlyhavania a Transplantacie, Bratislava, Slovakia.
  11. Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
  12. Heart Transplant Unit, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
  13. Emergency Cardiology Department, Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine.
  14. Cardiology Department, St. John of God Hospital, Budapest, Hungary.
  15. Amgen, Inc, Thousand Oaks, California.
  16. Clinical Research, Cytokinetics, South San Francisco, California.
  17. Research and Development, Cytokinetics, South San Francisco, California.
  18. Division of Cardiology, San Francisco VA Medical Center, San Francisco, California.
  19. Division of Cardiology, University of California San Francisco, San Francisco.

PMID: 34643642 PMCID: PMC8515258 DOI: 10.1001/jamacardio.2021.4027

Abstract

IMPORTANCE: Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients' condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies.

OBJECTIVE: To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS: The GALACTIC-HF study was a global double-blind, placebo-controlled phase 3 randomized clinical trial that was conducted at multiple centers between January 2017 and August 2020. A total of 8232 patients with symptomatic HF (defined as New York Heart Association symptom class II-IV) and left ventricular ejection fraction of 35% or less were randomized to receive omecamtiv mecarbil or placebo and followed up for a median of 21.8 months (range, 15.4-28.6 months). The current post hoc analysis evaluated the efficacy and safety of omecamtiv mecarbil therapy among patients classified as having severe HF compared with patients without severe HF. Severe HF was defined as the presence of all of the following criteria: New York Heart Association symptom class III to IV, left ventricular ejection fraction of 30% or less, and hospitalization for HF within the previous 6 months.

INTERVENTIONS: Participants were randomized at a 1:1 ratio to receive either omecamtiv mecarbil or placebo.

MAIN OUTCOMES AND MEASURES: The primary end point was time to first HF event or cardiovascular (CV) death. Secondary end points included time to CV death and safety and tolerability.

RESULTS: Among 8232 patients enrolled in the GALACTIC-HF clinical trial, 2258 patients (27.4%; mean [SD] age, 64.5 [11.6] years; 1781 men [78.9%]) met the specified criteria for severe HF. Of those, 1106 patients were randomized to the omecamtiv mecarbil group and 1152 to the placebo group. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit for the primary end point (hazard ratio [HR], 0.80; 95% CI, 0.71-0.90), whereas patients without severe HF had no significant treatment benefit (HR, 0.99; 95% CI, 0.91-1.08; P = .005 for interaction). For CV death, the results were similar (HR for patients with vs without severe HF: 0.88 [95% CI, 0.75-1.03] vs 1.10 [95% CI, 0.97-1.25]; P = .03 for interaction). Omecamtiv mecarbil therapy was well tolerated in patients with severe HF, with no significant changes in blood pressure, kidney function, or potassium level compared with placebo.

CONCLUSIONS AND RELEVANCE: In this post hoc analysis of data from the GALACTIC-HF clinical trial, omecamtiv mecarbil therapy may have provided a clinically meaningful reduction in the composite end point of time to first HF event or CV death among patients with severe HF. These data support a potential role of omecamtiv mecarbil therapy among patients for whom current treatment options are limited.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02929329.

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