Cytokinetics Announces Start of COMET-HF, a Confirmatory Phase 3 Clinical Trial of Omecamtiv Mecarbil in Patients with Symptomatic Heart Failure with Severely Reduced Ejection Fraction
CYTK 12.03.2024
Drug:unknown-unknown omecamtiv mecarbil
Diseases:heart failure

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“We are pleased to be starting COMET-HF to evaluateomecamtiv mecarbilin patients with severe heart failure who have limited treatment options and remain at high risk after failing guideline-directed medical therapy,” said
“Heart failure, and especially more severe forms of heart failure, is an area of major unmet need despite recent progress in developing more effective treatments,” said DCRI faculty member
COMET-HF is a Phase 3 multinational, multi-center, double-blind, randomized, placebo-controlled trial designed to assess the efficacy and safety ofomecamtiv mecarbilin patients with symptomatic heart failure with severely reduced ejection fraction. The primary endpoint of COMET-HF is the time to first event in the primary composite endpoint of cardiovascular death, first heart failure event, left ventricular assist device (LVAD) implantation or cardiac transplantation, or stroke. Secondary endpoints will evaluate the risk of individual components, including heart failure hospitalization, cardiovascular death, and stroke, as well as the risk of irreversible morbidity/mortality based on the composite endpoint of cardiovascular death, LVAD or cardiac implantation, or stroke.
COMET-HF is expected to randomize approximately 1,800 patients on a 1:1 basis to receiveomecamtiv mecarbilor placebo. At screening, patients enrolled in COMET-HF must have symptomatic heart failure with severely reduced ejection fraction defined as left ventricular ejection fraction <30%, NT-proBNP ≥1,000 pg/mL, and a heart failure event within the preceding six months.
Eligible patients will enter a two-week run-in period. Patients who are intolerant toomecamtiv mecarbil, are non-adherent, or have either undetectable or excessive plasma concentrations ofomecamtiv mecarbilwill not be eligible for randomization. Following the two-week run-in period, all patients will undergo a two-week washout period before being randomized to receiveomecamtiv mecarbil,up to a maximum dose of 50 mg twice daily based on the plasma concentration ofomecamtiv mecarbilduring the run-in period, or placebo. Patients will continue to receiveomecamtiv mecarbilor placebo twice daily until at least 850 primary composite endpoint events have occurred in the trial.
AboutOmecamtiv Mecarbil
Omecamtiv mecarbilis an investigational, selective, small molecule cardiac myosin activator, the first of a novel class of myotropes1designed to directly target the contractile mechanisms of the heart, binding to and recruiting more cardiac myosin heads to interact with actin during systole. In doing so,omecamtiv mecarbilaugments the impaired contractility that is associated with heart failure with reduced ejection fraction (HFrEF). Preclinical research has shown thatomecamtiv mecarbilincreases cardiac contractility without increasing intracellular myocyte calcium concentrations or myocardial oxygen consumption.2-4
The development program foromecamtiv mecarbilassessed its potential for the treatment of HFrEF. Positive results from GALACTIC-HF, the first Phase 3 clinical trial ofomecamtiv mecarbil, demonstrated a statistically significant effect of treatment withomecamtiv mecarbilto reduce risk of the primary composite endpoint of cardiovascular death or heart failure events (heart failure hospitalization and other urgent treatment for heart failure) compared to placebo in patients treated with standard of care. No reduction in the secondary endpoint of time to cardiovascular death was observed. In general, the overall rates of myocardial ischemia, ventricular arrhythmias, and death were similar between treatment and placebo groups. Adverse events and treatment discontinuation of study drug were balanced between treatment arms.5The magnitude of the treatment effect in a pre-specified subgroup of more than 4,500 patients with heart failure with severely reduced ejection fraction (<30%) was observed to be greater than in the overall drug treated population of GALACTIC-HF.6Omecamtiv mecarbilis now the subject of COMET-HF (Confirmation ofOmecamtivMecarbilEfficacyTrial inHeartFailure), a confirmatory Phase 3 clinical trial in patients with symptomatic heart failure with severely reduced ejection fraction.
About Heart Failure with Severely Reduced Ejection Fraction
Heart failure is a grievous condition that affects more than 64 million people worldwide5, about half of whom have reduced left ventricular function.8,9HF is the leading cause of hospitalization and readmission in people age 65 and older.10,11By 2029, is it estimated that 2.8 million people in the
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References:
- Psotka MA, Gottlieb SS, Francis GS et al. Cardiac Calcitropes, Myotropes, and Mitotropes.JACC. 2019; 73:2345-53.
- Planelles-Herrero VJ, Hartman JJ, Robert-Paganin J. et al. Mechanistic and structural basis for activation of cardiac myosin force production by omecamtiv mecarbil.
Nat Commun . 2017;8:190. - Shen YT, Malik FI, Zhao X, et al. Improvement of cardiac function by a cardiac myosin activator in conscious dogs with systolic heart failure.Circ Heart Fail. 2010; 3: 522-27.
- Malik FI, Hartman JJ, Elias KA, Morgan BP, Rodriguez H, Brejc K, Anderson RL, Sueoka SH, Lee KH, Finer JT, Sakowicz R. Cardiac myosin activation: a potential therapeutic approach for systolic heart failure.Science. 2011 Mar 18;331(6023):1439-43.
- Teerlink JR, et al. Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure.NEJM. 2021;384:105–16.
- Teerlink JR, et al. Effect of ejection fraction on clinical outcomes in patients treated with omecamtiv mecarbil in GALACTIC-HF.
Journal of the American College of Cardiology . 2021;78:97–108 - James et al. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators.
Lancet 2018; 392: 1789–858. - Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2013;128:e240-e327.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016;37:2129–2200.
- Roger VL. Epidemiology of Heart Failure.
Circulation Research . 2013;113:646-659, originally published August 29, 2013. doi: 10.1161/CIRCRESAHA.113.300268. - Kilgore M, Patel HK, Kielhorn A, et al. Economic burden of hospitalizations of Medicare beneficiaries with heart failure.Risk Manag Healthc Policy. 2017; 10: 63-70.
- Taylor C J, Ordóñez-Mena J M, Roalfe A K, et al. Trends in survival after a diagnosis of heart failure in the
United Kingdom 2000-2017: population based cohort study.BMJ2019; 364:l223 doi:10.1136/bmj.l223 - Greene SJ, Bauersachs J, Brugts JJ, et al.Worsening Heart Failure: Nomenclature, Epidemiology, and Future Directions: JACC Review Topic of the Week.JACC. 2023 Jan 31;81(4):413-424. doi:10.1016/j.jacc.2022.11.023. PMID: 36697141.
- Extrapolated from Desai NR, Butler J, Binder G, et al.Prevalence and Excess Risk of Hospitalization in Heart Failure with Reduced Ejection Fraction.Poster presented at: Heart Failure Society of America (HFSA) Annual
Scientific Meeting ; 2022Sep 30-Oct 3 ;Washington, DC . - Carnicelli AP, Clare RM, Hofmann P, et al.Clinical trajectory of patients with a worsening heart failure event and reduced ventricular ejection fraction.Am Heart J.2022 Mar; 245:110-116. doi: 10.1016/j.ahj.2021.12.003. Epub 2021 Dec 18. PMID: 34932997.

Source: Cytokinetics, Incorporated