Mavacamten Treatment for Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- PMID: 36167226
- DOI: 10.1016/j.cpcardiol.2022.101429
Mavacamten Treatment for Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, yet pharmacological therapy has been unchanged for decades until the recent introduction of mavacamten, a first-in-class cardiac myosin inhibitor. We assessed the efficacy and safety of mavacamten in HCM. To date, only 3 randomized controlled trials (RCTs) compared the outcomes of mavacamten vs placebo for HCM. We used a fixed effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). The primary composite endpoint (PCE) was defined as either ≥1.5 mL/kg/min increase in peak oxygen consumption (pVO2) with ≥1 New York Heart Association functional class (NYHA-FC) improvement or ≥3.0 mL/kg/min increase in pVO2 without worsening of NYHA-FC. Secondary outcomes included ≥1 NYHA-FC improvement, septal reduction therapy (SRT) or guideline eligible for SRT, ≥1 serious adverse event (SAE), ≥1 treatment emergency adverse event (TEAE), atrial fibrillation (AF), and nonsustained ventricular tachycardia (NSVT). Three RCTs (n = 422, mean follow-up 24 weeks) were included. Compared to placebo, mavacamten achieved higher rates of PCE (RR 1.92; 95% CI 1.28-2.88; P = 0.002) and ≥1 NYHA-FC improvement (RR 2.10; 95% CI 1.66-2.67; P < 0.00001) and lower rates of SRT or guideline eligible for SRT (RR 0.29; 95% CI 0.22-0.39; P < 0.00001). There were no differences between both groups in ≥1 SAE, AF, and NSVT, however mavacamten had higher rates of ≥1 TEAE. In patients with HCM, mavacamten helps improve pVO2 and NYHA-FC and reduces SRT but may be associated with TEAE. Further research is warranted to evaluate the efficacy, safety, and long-term outcomes of mavacamten.
Copyright © 2022 Elsevier Inc. All rights reserved.
Similar articles
-
A systematic review and meta-analysis of the efficacy and safety of Mavacamten therapy in international cohort of 524 patients with hypertrophic cardiomyopathy.Heart Fail Rev. 2024 Mar;29(2):479-496. doi: 10.1007/s10741-023-10375-6. Epub 2023 Dec 19. Heart Fail Rev. 2024. PMID: 38112937 Review.
-
Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial.Lancet. 2020 Sep 12;396(10253):759-769. doi: 10.1016/S0140-6736(20)31792-X. Epub 2020 Aug 29. Lancet. 2020. PMID: 32871100 Clinical Trial.
-
Evaluating the efficacy and safety of mavacamten in hypertrophic cardiomyopathy: A systematic review and meta-analysis focusing on qualitative assessment, biomarkers, and cardiac imaging.PLoS One. 2024 Apr 18;19(4):e0301704. doi: 10.1371/journal.pone.0301704. eCollection 2024. PLoS One. 2024. PMID: 38635724 Free PMC article.
-
Study design and rationale of VALOR-HCM: evaluation of mavacamten in adults with symptomatic obstructive hypertrophic cardiomyopathy who are eligible for septal reduction therapy.Am Heart J. 2021 Sep;239:80-89. doi: 10.1016/j.ahj.2021.05.007. Epub 2021 May 24. Am Heart J. 2021. PMID: 34038706
-
Efficacy and Safety of Mavacamten in the Treatment of Hypertrophic Cardiomyopathy: A Systematic Review.Heart Lung Circ. 2023 Sep;32(9):1049-1056. doi: 10.1016/j.hlc.2023.05.019. Epub 2023 Jul 14. Heart Lung Circ. 2023. PMID: 37453852 Review.
Cited by
-
Efficacy and safety of Mavacamten for symptomatic Hypertrophic cardiomyopathy - an updated Meta-Analysis of randomized controlled trials.Int J Cardiol Heart Vasc. 2024 Jul 13;53:101467. doi: 10.1016/j.ijcha.2024.101467. eCollection 2024 Aug. Int J Cardiol Heart Vasc. 2024. PMID: 39108740 Free PMC article. Review.
-
Analyzing safety and effectiveness of Mavacamten in comparison with placebo for managing hypertrophic cardiomyopathy: a systemic review and meta-analysis.Egypt Heart J. 2023 Dec 2;75(1):99. doi: 10.1186/s43044-023-00427-5. Egypt Heart J. 2023. PMID: 38041770 Free PMC article.
-
Efficacy and safety of mavacamten in treatment of hypertrophic cardiomyopathy: a systematic review and meta-analysis.Future Sci OA. 2023 Sep 19;9(10):FSO898. doi: 10.2144/fsoa-2023-0059. eCollection 2023 Dec. Future Sci OA. 2023. PMID: 37753355 Free PMC article.
-
Hypertrophic Cardiomyopathy versus Storage Diseases with Myocardial Involvement.Int J Mol Sci. 2023 Aug 26;24(17):13239. doi: 10.3390/ijms241713239. Int J Mol Sci. 2023. PMID: 37686045 Free PMC article. Review.
-
Comparing the efficacy and safety of medications in adults with hypertrophic cardiomyopathy: a systematic review and network meta-analysis.Front Cardiovasc Med. 2023 Aug 14;10:1190181. doi: 10.3389/fcvm.2023.1190181. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 37645523 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical