GALACTIC-HF: Omecamtiv mecarbil as option for HFrEF patients with low SBP

Although patients with heart failure with reduced ejection fraction (HFrEF) and low systolic blood pressure (SBP, <100 mmHg) displayed a higher risk of heart failure (HF) outcomes in a subanalysis of the GALACTIC-HF trial, treatment with omecamtiv mecarbil reduced this risk more distinctively in patients with a low SBP. Since placebo and omecamtiv mecarbil showed similar safety profiles, this agent may be a valid option for the hard-to-treat population of patients with HFrEF and low SBP.

“Patients with HFrEF and low SBP are at increased risk of clinical events and do not tolerate guideline-directed medical therapy well,” explained Prof. Marco Metra (University of Brescia, Italy) [1]. Omecamtiv mecarbil is a selective cardiac myosin activator that improves cardiac function, without reducing blood pressure and might benefit these patients with HFrEF and low SBP. Prof. Metra and colleagues analysed the efficacy and safety of omecamtiv mecarbil in patients with HFrEF and low SBP (≤100 mmHg) in the phase 3 GALACTIC-HF trial (NCT02929329; total n=8,232; low SBP n=1,473). The primary analysis showed a significant benefit of omecamtiv mecarbil over placebo in time-to-first HF event or cardiovascular death in the overall population (HR 0.92; P=0.025) [2].

The current subanalysis showed that participants with a low SBP had a higher risk of HF events than participants with an SBP >100 mmHg (HR 1.05 per 5 mmHg; P<0.001). However, the treatment effect of omecamtiv mecarbil on cardiovascular death or time-to-first HF event was larger in those with a low SBP (HR 0.81) than in those with a higher SBP (HR 0.95; P_interaction=0.051; see Figure). The safety profiles of omecamtiv mecarbil and placebo were similar in both SBP groups. Thus, the authors concluded that the challenging population of patients with HFrEF and low SBP may benefit from treatment with omecamtiv mecarbil.

Figure: Kaplan Meier curves for the primary endpoint by SBP subgroups [1]



SBP, systolic blood pressure; ARR, absolute risk reduction; OM, omecamtiv mecarbil; HR, hazard ratio.

1. Metra M, et al. GALACTIC-HF – omecamtiv mecarbil in HFrEF and low blood pressure. LBT Pharmacological treatment I, Heart Failure 2022, 21–24 May, Madrid, Spain.
2. Teerlink JR, et al. JACC Heart Fail. 2020;8:329–340.

 

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Posted on 28 July, 202223 April, 2024