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Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial.

Publication ,  Journal Article
Lewis, GD; Voors, AA; Cohen-Solal, A; Metra, M; Whellan, DJ; Ezekowitz, JA; Böhm, M; Teerlink, JR; Docherty, KF; Lopes, RD; Divanji, PH ...
Published in: JAMA
July 19, 2022

IMPORTANCE: Exercise limitation is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but is not consistently improved by any of the current guideline-directed medical therapies. OBJECTIVE: To determine whether omecamtiv mecarbil, a novel direct myosin activator that improves cardiac performance and reduces the risk for cardiovascular death or first HF event in HFrEF, can improve peak exercise capacity in patients with chronic HFrEF. DESIGN, SETTING, AND PARTICIPANTS: Phase 3, double-blind, placebo-controlled randomized trial of patients with HFrEF (left ventricular ejection fraction ≤35%), New York Heart Association class II-III symptoms, N-terminal pro-B-type natriuretic peptide level of 200 pg/mL or greater, and baseline peak oxygen uptake (V̇o2) of 75% or less of predicted. Patients were randomized in a 2:1 ratio (omecamtiv mecarbil to placebo) between March 2019 and May 2021 at 63 sites in North America and Europe, with the last patient visit occurring on November 29, 2021. INTERVENTIONS: Omecamtiv mecarbil (n = 185) or matching placebo (n = 91), given orally twice daily at a dose of 25 mg, 37.5 mg, or 50 mg based on target plasma levels, for 20 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was a change in exercise capacity (peak V̇o2) from baseline to week 20. Secondary end points included total workload, ventilatory efficiency, and daily physical activity as determined by accelerometry. RESULTS: Among 276 patients who were randomized (median age, 64 years; IQR, 55-70 years; 42 women [15%]), 249 (90%) completed the trial. The median left ventricular ejection fraction was 28% (IQR, 21-33) and the median baseline peak V̇o2 was 14.2 mL/kg/min (IQR, 11.6-17.4) in the omecamtiv mecarbil group and 15.0 mL/kg/min (IQR, 12.0-17.2) in the placebo group. Mean change in peak V̇o2 did not differ significantly between the omecamtiv mecarbil and placebo groups (mean, -0.24 mL/kg/min vs 0.21 mL/kg/min; least square mean difference, -0.45 mL/kg/min [95% CI, -1.02 to 0.13]; P = .13). Adverse events included dizziness (omecamtiv mecarbil: 4.9%, placebo: 5.5%), fatigue (omecamtiv mecarbil: 4.9%, placebo: 4.4%), heart failure events (omecamtiv mecarbil: 4.9%, placebo: 4.4%), death (omecamtiv mecarbil: 1.6%, placebo: 1.1%), stroke (omecamtiv mecarbil: 0.5%, placebo: 1.1%), and myocardial infarction (omecamtiv mecarbil: 0%, placebo: 1.1%). CONCLUSIONS AND RELEVANCE: In patients with chronic HFrEF, omecamtiv mecarbil did not significantly improve exercise capacity over 20 weeks compared with placebo. These findings do not support the use of omecamtiv mecarbil for treatment of HFrEF for improvement of exercise capacity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03759392.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 19, 2022

Volume

328

Issue

3

Start / End Page

259 / 269

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Urea
  • Stroke Volume
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female
 

Citation

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Lewis, G. D., Voors, A. A., Cohen-Solal, A., Metra, M., Whellan, D. J., Ezekowitz, J. A., … Felker, G. M. (2022). Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial. JAMA, 328(3), 259–269. https://doi.org/10.1001/jama.2022.11016
Lewis, Gregory D., Adriaan A. Voors, Alain Cohen-Solal, Marco Metra, David J. Whellan, Justin A. Ezekowitz, Michael Böhm, et al. “Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial.JAMA 328, no. 3 (July 19, 2022): 259–69. https://doi.org/10.1001/jama.2022.11016.
Lewis GD, Voors AA, Cohen-Solal A, Metra M, Whellan DJ, Ezekowitz JA, et al. Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):259–69.
Lewis, Gregory D., et al. “Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial.JAMA, vol. 328, no. 3, July 2022, pp. 259–69. Pubmed, doi:10.1001/jama.2022.11016.
Lewis GD, Voors AA, Cohen-Solal A, Metra M, Whellan DJ, Ezekowitz JA, Böhm M, Teerlink JR, Docherty KF, Lopes RD, Divanji PH, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Felker GM. Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):259–269.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 19, 2022

Volume

328

Issue

3

Start / End Page

259 / 269

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Urea
  • Stroke Volume
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female