Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Placebo in Adults With Symptomatic nHCM

Launched by CYTOKINETICS · Oct 12, 2023

Keywords

ClinConnect Summary

This clinical trial is looking at a medication called aficamten to see how well it works for adults with symptomatic non-obstructive hypertrophic cardiomyopathy (nHCM), a condition where the heart muscle becomes thick and can cause problems with heart function. The study aims to understand if aficamten can improve patients' quality of life, their ability to exercise, and overall health outcomes compared to a placebo, which is a harmless dummy treatment.

To be eligible for the trial, participants need to be between 18 and 85 years old and have been diagnosed with nHCM. They should also meet specific health criteria, including certain measurements from heart tests and a particular level of symptoms, but they shouldn’t have significant heart valve disease or other serious heart conditions. If chosen to participate, individuals will be closely monitored throughout the study, receiving either the medication or placebo, and will have regular check-ups to assess their health and any changes in their symptoms. This trial is currently recruiting participants, so those interested should talk to their healthcare provider for more details.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Between 18-85 years of age
• • Body mass index \< 40 kg/m2
• * Diagnosed with nHCM and has a screening echocardiogram with the following:
• * End-diastolic left ventricular (LV) wall thickness:
• • ≥ 15 mm in one or more myocardial segments OR
• • ≥ 13 mm in one or more wall segments and a known disease-causing gene mutation or positive family history of HCM AND
• • Resting LVOT-G \< 30 mmHg AND Valsalva LVOT-G \< 50 mmHg AND
• • LVEF ≥ 60%
• • Participants with a history of intracavitary obstruction are eligible.
• • NYHA class II or III
• • Respiratory exchange ratio of ≥ 1.00 at screening by cardiopulmonary exercise testing (CPET) and predicted peak oxygen uptake (pVO2) ≤ 90% for age and sex
• • KCCQ-CSS score of ≤ 85
• * NT-proBNP of:
• • NT-pro BNP ≥ 300 pg/mL or NT-proBNP ≥ 900 pg/mL if in atrial fibrillation or atrial flutter OR
• • For Black participants, an NT-pro BNP ≥ 225 pg/mL or NT-proBNP ≥ 675 pg/mL if in atrial fibrillation or atrial flutter
• Exclusion Criteria:
• • Significant valvular heart disease (per Investigator judgment)
• • Moderate or severe valvular aortic stenosis or fixed subaortic obstruction
• • Moderate or severe mitral regurgitation
• • Known or suspected infiltrative, genetic or storage disorder causing cardiac hypertrophy that mimics nHCM (eg, Noonan syndrome, Fabry disease, amyloidosis)
• • Known current unrevascularized coronary artery stenosis of ≥ 70% or documented history of myocardial infarction.
• • History of LV systolic dysfunction (LVEF \< 45%) or stress cardiomyopathy
• • Inability to exercise on a treadmill or bicycle (eg, orthopedic limitations)
• • Documented room air oxygen saturation reading \< 90% at screening or history of significant chronic obstructive pulmonary disease or severe/significant pulmonary hypertension
• • History of syncope, symptomatic ventricular arrhythmia, or sustained ventricular tachyarrhythmia with exercise within 3 months prior to screening
• • History of resistant hypertension (persistently elevated blood pressure despite maximal doses of 3 or more classes of medications for hypertension control)
• • Screening diastolic blood pressure ≥ 100 mmHg
• • Received prior treatment with aficamten
• • Received treatment with mavacamten within 3 months prior to screening (must be discussed with the medical monitor prior to screening)
• • Undergone septal reduction therapy \< 6 months prior to screening
• • Is being considered for or is likely to be considered for heart transplant listing or left ventricular assist device placement during the study period
• * Paroxysmal or permanent atrial fibrillation is excluded only if:
• • rhythm restoring treatment (e.g., direct-current cardioversion, atrial fibrillation ablation procedure, or antiarrhythmic therapy) has been required ≤ 3 months prior to screening
• • rate control and anticoagulation have not been achieved for at least 3 months prior to screening.