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RabieeRad M, GhasempourDabaghi G, Zare MM, Amani-Beni R. Novel Treatments of Hypertrophic Cardiomyopathy in GDMT for Heart Failure: A State-of-art Review. Curr Probl Cardiol 2023; 48:101740. [PMID: 37054829 DOI: 10.1016/j.cpcardiol.2023.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
This state-of-the-art review discuss the available evidence on the use of novel treatments of hypertrophic cardiomyopathy such as omecamtiv mecarbil, EMD-57033, levosimendan, pimobendan, and mavacamten for the treatment of heart failure (HF) in the context of guideline-directed medical therapy (GDMT). The paper provides a detailed overview of these agents' mechanisms of action, potential benefits and limitations, and their effects on clinical outcomes. The review also evaluates the efficacy of the novel treatments in comparison to traditional medications such as digoxin. Finally, we seek to provide insight and guidance to clinicians and researchers in the management of HF patients.
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Affiliation(s)
- Mehrdad RabieeRad
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Mohammad M Zare
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Alqatati F, Elbahnasawy M, Bugazia S, Ragab KM, Elsnhory AB, Shehata M, Elsayed SM, Fathy MA, Nourelden AZ. Safety and efficacy of omecamtiv mecarbil for heart failure: A systematic review and meta-analysis. Indian Heart J 2022; 74:155-162. [PMID: 35301008 PMCID: PMC9243594 DOI: 10.1016/j.ihj.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/20/2022] [Accepted: 03/12/2022] [Indexed: 01/10/2023] Open
Abstract
AIM To assess the safety and efficacy of omecamtiv mecarbil compared with placebo in heart failure (HF) patients. METHODS We searched PubMed, Web of Science, Cochrane Library, and SCOPUS until August 15th, 2021. We included all randomized controlled studies comparing omecamtiv mecarbil with placebo in heart failure patients. The meta-analysis was carried out using Rev Man software V5.4. RESULTS A total of eight studies were included in our systematic review. Pooled analysis showed that omecamtiv mecarbil is not associated with increased incidence of death, any adverse events, hypotension, heart failure, ventricular tachyarrhythmia, dyspnea, dizziness, and serious adverse events. Regarding the efficacy, omecamtiv mecarbil significantly reduced heart rate with some studies demonstrating its significant improvement in left ventricular ejection fraction and systolic function. CONCLUSION Omecamtiv mecarbil is a well-tolerated drug in heart failure patients. The limited data regarding the efficacy suggested that it may improve ejection fraction and systolic function.
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Affiliation(s)
- Fadel Alqatati
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammad Elbahnasawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt; International Medical Research Association (IMedRA), Egypt
| | - Seif Bugazia
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Khaled Mohamed Ragab
- Faculty of Medicine, Minia University, Minia, Egypt; International Medical Research Association (IMedRA), Egypt.
| | | | - Mostafa Shehata
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sarah Makram Elsayed
- Faculty of Medicine, October 6 University, Giza, Egypt; International Medical Research Association (IMedRA), Egypt
| | | | - Anas Zakarya Nourelden
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt; International Medical Research Association (IMedRA), Egypt
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Trivedi A, Sohn W, Hsu CP, Jafarinasabian P, Zhang H, Hutton S, Flach S, Abbasi S, Dutta S, Lee E. Pharmacokinetic Drug-Drug Interaction Study of Omecamtiv Mecarbil With Amiodarone and Digoxin in Healthy Subjects. Clin Pharmacol Drug Dev 2021; 11:388-396. [PMID: 34634185 PMCID: PMC9293137 DOI: 10.1002/cpdd.1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/07/2021] [Indexed: 01/10/2023]
Abstract
Omecamtiv mecarbil (OM), a novel cardiac myosin activator, is being evaluated for the treatment of heart failure with reduced ejection fraction. In vitro studies demonstrate OM as a substrate and inhibitor of P-glycoprotein (P-gp), which can result in drug-drug interactions. Two phase 1, open-label studies assessed the effect of coadministration of OM (50-mg single dose) on the pharmacokinetics of digoxin (0.5-mg single dose; N = 15), a P-gp substrate, and the effect of coadministration of amiodarone (600-mg single dose), a P-gp inhibitor, on the pharmacokinetics of OM (50-mg single dose; N = 14) in healthy subjects. The ratios of the geometric least squares mean (90% confidence interval [CI]) of digoxin coadministered with OM vs digoxin alone for area under the plasma concentration-time curve (AUC) from time 0 to infinity, AUC from time 0 to the time of the last quantifiable concentration, and maximum observed plasma concentration were 1.06 (90%CI, 0.99-1.14), 1.06 (90%CI, 0.98-1.14), and 1.08 (90%CI, 0.92-1.26), respectively. The ratios of the geometric least squares mean of OM coadministered with amiodarone vs OM alone for AUC from time 0 to infinity, AUC from time 0 to the time of the last quantifiable concentration, and maximum observed plasma concentration were 1.21 (90%CI, 1.08-1.36), 1.21 (90%CI, 1.07-1.36), and 1.08 (90%CI, 0.96-1.22), respectively. In conclusion, OM coadministered with digoxin or amiodarone did not result in any clinically relevant pharmacokinetic drug-drug interactions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Edward Lee
- Amgen Inc, Thousand Oaks, California, USA
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Trivedi A, Malik FI, Mackowski M, Hutton S, Aoki M, Abbasi S, Dutta S, Lee E. Pharmacokinetics, Tolerability, and Safety of Single and Multiple Omecamtiv Mecarbil Doses in Healthy Japanese and Caucasian Subjects. Eur J Drug Metab Pharmacokinet 2021; 46:759-770. [PMID: 34415561 DOI: 10.1007/s13318-021-00711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Omecamtiv mecarbil (OM) is a cardiac myosin activator under development for the treatment of heart failure. The pharmacokinetics of single and multiple doses of OM were investigated in healthy Japanese subjects in two clinical studies. METHODS Study 1 (n = 36) evaluated the bioavailability and pharmacokinetics after intravenous infusion (15 mg/h for 4 h) and an oral modified release (MR) tablet in healthy Japanese and Caucasian subjects using 25 mg single and multiple doses and 50 mg single dose. Study 2 (n = 50) evaluated the pharmacokinetics of OM with multiple oral doses of 25 mg MR tablets twice a day (BID) followed by up-titration to either 37.5 mg or 50 mg BID in healthy Japanese subjects. RESULTS In Study 1, the maximum observed plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC) from time 0 to infinity (AUCinf) in Japanese subjects after a single oral dose of 50 mg were twice that at the 25 mg dose, consistent with that observed in Caucasian subjects. Following single oral doses of 25 mg and 50 mg, absolute bioavailability was 56.5% and 59.2% for Japanese subjects and 63.1 and 83.6% for Caucasian subjects, respectively. No ethnic differences were observed in the pharmacokinetics of OM and its metabolites following single and multiple doses of 25 mg and 50 mg. In Study 2, the mean accumulation ratios based on AUC from 0 to 12 h (AUC12) were approximately four-fold from day 1 to day 8 and from day 20 to day 27 across ethnic groups. The mean ratios of Cmax to predose concentrations (Cpredose) ranged from 1.25 to 1.38 across subgroups. CONCLUSIONS OM showed consistent and predictable pharmacokinetics after multiple dosing in Japanese subjects.
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Affiliation(s)
- Ashit Trivedi
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | | | - Mia Mackowski
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Shauna Hutton
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | | | - Siddique Abbasi
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Sandeep Dutta
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Edward Lee
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
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Trivedi A, Sohn W, Jafarinasabian P, Zhang H, Terminello B, Flach S, Abbasi S, Dutta S, Lee E. Pharmacokinetic Drug-Drug Interaction Study of Omecamtiv Mecarbil With Omeprazole, a Proton Pump Inhibitor, in Healthy Subjects. Clin Pharmacol Drug Dev 2021; 11:129-133. [PMID: 34272833 DOI: 10.1002/cpdd.997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022]
Abstract
Omecamtiv mecarbil (OM) is a novel cardiac myosin activator in development for the treatment of heart failure (HF) with reduced ejection fraction. OM is administered as a 25-, 37.5-, or 50-mg modified-release formulation in patients with HF. Proton pump inhibitors are one of the most commonly prescribed drugs in this patient population. Given the potential for coadministration of both drugs in patients with HF, we evaluated the potential for omeprazole to affect the pharmacokinetics of OM in an open-label study in 14 healthy subjects. Subjects received a single 50-mg dose of OM on day 1, followed by 40-mg once-daily doses of omeprazole on days 4 to 8. On day 9, a single 40-mg dose of omeprazole was administered first and immediately followed by 50-mg of OM. Blood samples were collected up to 144 hours after dosing following administration of OM on days 1 and 9 to characterize plasma concentrations of OM. The ratios of the geometric least-square means (90% confidence intervals) of OM coadministered with omeprazole compared to OM alone were 94.5% (81.7%-109.3%), 94.3% (81.5%-109.1%), and 101.2% (95.4%-107.3%) for area under the plasma concentration-time curve from time 0 to infinity, area under the plasma concentration-time curve from time 0 to the last measurable concentration, and maximum observed plasma concentration, respectively. Coadministration of OM with omeprazole was not associated with any clinically significant pharmacokinetic drug interactions. Single doses of OM were safe and well tolerated when coadministered with omeprazole.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Edward Lee
- Amgen Inc, Thousand Oaks, California, USA
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Trivedi A, Hsu CP, Jafarinasabian P, Terminello B, Zhang H, Flach S, Israel S, Brooks A, Xue H, Darpo B, Abbasi S, Dutta S, Lee E. Omecamtiv mecarbil does not prolong QTc intervals at therapeutic concentrations. Br J Clin Pharmacol 2021; 88:187-198. [PMID: 34131942 DOI: 10.1111/bcp.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Omecamtiv mecarbil (OM) is a novel selective cardiac myosin activator under investigation for the treatment of heart failure. This study aimed to evaluate the effect of therapeutic concentrations of OM on electrocardiogram (ECG) parameters and exclude a clinically concerning effect on the rate-corrected QT (QTc) interval. METHODS In part A, 70 healthy subjects received a 25 mg oral dose of OM, and pharmacokinetics were assessed. Only subjects with maximum observed plasma concentration ≤ 350 ng/mL (n = 60) were randomized into part B, where they received a single oral dose of placebo, 50 mg OM and 400 mg moxifloxacin in a 3-period, 3-treatment, 6-sequence crossover study with continuous ECG collection. RESULTS After a 50-mg dose of OM, mean placebo-corrected change from baseline QTcF (∆∆QTcF; Fridericia correction) ranged from -6.7 ms at 1 hour postdose to -0.8 ms at 4 hours postdose. The highest upper bound of the 1-sided 95% confidence interval (CI) was 0.7 ms (4 h postdose). Moxifloxacin resulted in a clear increase in mean ∆∆QTcF, with a peak value of 13.1 ms (90% CI: 11.71-14.57) at 3 hours; lower bound of the 1-sided 95% CI was > 5 ms at all of the 3 prespecified time points. Based on a concentration-QTc analysis, an effect on ∆∆QTcF exceeding 10 ms can be excluded up to OM plasma concentrations of ~800 ng/mL. There were no serious or treatment-emergent adverse events leading to discontinuation from the study. CONCLUSION OM does not have a clinically relevant effect on the studied ECG parameters.
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