1
|
Lanfear DE, Njoroge JN, Adams KF, Anand I, Fang JC, Ramires F, Sliwa-Hahnle K, Badat A, Burgess L, Gorodeski EZ, Williams C, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon S, Miao ZM, Claggett BL, Heitner SB, Kupfer S, Malik FI, Teerlink JR. Omecamtiv Mecarbil in Black Patients With Heart Failure and Reduced Ejection Fraction: Insights From GALACTIC-HF. JACC Heart Fail 2023; 11:569-579. [PMID: 36881396 DOI: 10.1016/j.jchf.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. OBJECTIVES The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. METHODS In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. RESULTS Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro-B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs -0.7 mm Hg, P-interaction = 0.02). CONCLUSIONS GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.
Collapse
Affiliation(s)
| | - Joyce N Njoroge
- University of California San Francisco, San Francisco, California, USA
| | | | - Inder Anand
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Felix Ramires
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Aysha Badat
- Wits Clinical Research, Johannesburg, South Africa
| | - Lesley Burgess
- TREAD Research, Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
| | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | - Gary M Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Brian L Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, California, USA
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Bravo L, Smolenov I, Han HH, Li P, Hosain R, Rockhold F, Clemens SAC, Roa C, Borja-Tabora C, Quinsaat A, Lopez P, López-Medina E, Brochado L, Hernández EA, Reynales H, Medina T, Velasquez H, Toloza LB, Rodriguez EJ, de Salazar DIM, Rodríguez CA, Sprinz E, Cerbino-Neto J, Luz KG, Schwarzbold AV, Paiva MS, Carlos J, Montellano MEB, de Los Reyes MRA, Yu CY, Alberto ER, Panaligan MM, Salvani-Bautista M, Buntinx E, Hites M, Martinot JB, Bhorat QE, Badat A, Baccarini C, Hu B, Jurgens J, Engelbrecht J, Ambrosino D, Richmond P, Siber G, Liang J, Clemens R. Efficacy of the adjuvanted subunit protein COVID-19 vaccine, SCB-2019: a phase 2 and 3 multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2022; 399:461-472. [PMID: 35065705 PMCID: PMC8776284 DOI: 10.1016/s0140-6736(22)00055-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A range of safe and effective vaccines against SARS CoV 2 are needed to address the COVID 19 pandemic. We aimed to assess the safety and efficacy of the COVID-19 vaccine SCB-2019. METHODS This ongoing phase 2 and 3 double-blind, placebo-controlled trial was done in adults aged 18 years and older who were in good health or with a stable chronic health condition, at 31 sites in five countries (Belgium, Brazil, Colombia, Philippines, and South Africa). The participants were randomly assigned 1:1 using a centralised internet randomisation system to receive two 0·5 mL intramuscular doses of SCB-2019 (30 μg, adjuvanted with 1·50 mg CpG-1018 and 0·75 mg alum) or placebo (0·9% sodium chloride for injection supplied in 10 mL ampoules) 21 days apart. All study staff and participants were masked, but vaccine administrators were not. Primary endpoints were vaccine efficacy, measured by RT-PCR-confirmed COVID-19 of any severity with onset from 14 days after the second dose in baseline SARS-CoV-2 seronegative participants (the per-protocol population), and the safety and solicited local and systemic adverse events in the phase 2 subset. This study is registered on EudraCT (2020-004272-17) and ClinicalTrials.gov (NCT04672395). FINDINGS 30 174 participants were enrolled from March 24, 2021, until the cutoff date of Aug 10, 2021, of whom 30 128 received their first assigned vaccine (n=15 064) or a placebo injection (n=15 064). The per-protocol population consisted of 12 355 baseline SARS-CoV-2-naive participants (6251 vaccinees and 6104 placebo recipients). Most exclusions (13 389 [44·4%]) were because of seropositivity at baseline. There were 207 confirmed per-protocol cases of COVID-19 at 14 days after the second dose, 52 vaccinees versus 155 placebo recipients, and an overall vaccine efficacy against any severity COVID-19 of 67·2% (95·72% CI 54·3-76·8), 83·7% (97·86% CI 55·9-95·4) against moderate-to-severe COVID-19, and 100% (97·86% CI 25·3-100·0) against severe COVID-19. All COVID-19 cases were due to virus variants; vaccine efficacy against any severity COVID-19 due to the three predominant variants was 78·7% (95% CI 57·3-90·4) for delta, 91·8% (44·9-99·8) for gamma, and 58·6% (13·3-81·5) for mu. No safety issues emerged in the follow-up period for the efficacy analysis (median of 82 days [IQR 63-103]). The vaccine elicited higher rates of mainly mild-to-moderate injection site pain than the placebo after the first (35·7% [287 of 803] vs 10·3% [81 of 786]) and second (26·9% [189 of 702] vs 7·4% [52 of 699]) doses, but the rates of other solicited local and systemic adverse events were similar between the groups. INTERPRETATION Two doses of SCB-2019 vaccine plus CpG and alum provides notable protection against the entire severity spectrum of COVID-19 caused by circulating SAR-CoV-2 viruses, including the predominating delta variant. FUNDING Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.
Collapse
Affiliation(s)
- Lulu Bravo
- University of the Philippines Manila, Ermita, Manila, Philippines
| | | | | | - Ping Li
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | | | - Frank Rockhold
- Duke University Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Camilo Roa
- Manila Doctors Hospital, Manila, Philippines
| | | | | | - Pio Lopez
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | | | | | | | - Tatiana Medina
- Center of Attention in Medical Research, Bogotá, Colombia
| | | | | | | | | | | | - Eduardo Sprinz
- Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Maria Sanali Paiva
- Atena Institute of Clinical Research, Rio Grande do Norte, Natal, Brazil
| | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Charles Y Yu
- De La Salle Medical and Health Sciences Institute, Cavite City, Philippines
| | | | - Mario M Panaligan
- Infection Control Service, St Luke's Medical Center, Taguig, Philippines
| | | | | | - Maya Hites
- Clinic of Infectious Diseases, CUB-Hôpital Erasme, Bruxelles, Belgium
| | - Jean-Benoit Martinot
- Pulmonology Department, CHU Universite Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Qasim E Bhorat
- Soweto Clinical Trials Centre, Johannesburg, South Africa
| | - Aysha Badat
- Wits Clinical Research, Soweto, Johannesburg, South Africa
| | | | - Branda Hu
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | - Jaco Jurgens
- DJW Research, Noordheuwel, Krugersdorp, Gauteng, South Africa
| | - Jan Engelbrecht
- Dr JM Engelbrecht Trial Site, Vergelegen Mediclinic, Western Cape, South Africa
| | | | - Peter Richmond
- Division of Paediatrics, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | | | | | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil.
| |
Collapse
|