Evaluating the efficacy and safety of mavacamten in hypertrophic cardiomyopathy: A systematic review and meta-analysis focusing on qualitative assessment, biomarkers, and cardiac imaging.

BackgroundHypertrophic Cardiomyopathy (HCM) is a complex cardiac condition characterized by hypercontractility of cardiac muscle leading to a dynamic obstruction of left ventricular outlet tract (LVOT). Mavacamten, a first-in-class cardiac myosin inhibitor, is increasingly being studied in randomized controlled trials. In this meta-analysis, we aimed to analyse the efficacy and safety profile of Mavacamten compared to placebo in patients of HCM.MethodWe carried out a comprehensive search in PubMed, Cochrane, and clinicaltrials.gov to analyze the efficacy and safety of mavacamten compared to placebo from 2010 to 2023. To calculate pooled odds ratio (OR) or risk ratio (RR) at 95% confidence interval (CI), the Mantel-Haenszel formula with random effect was used and Generic Inverse Variance method assessed pooled mean difference value at a 95% CI. RevMan was used for analysis. PResultsWe analyzed five phase 3 RCTs including 609 patients to compare mavacamten with a placebo. New York Heart Association (NYHA) grade improvement and KCCQ score showed the odds ratio as 4.94 and 7.93 with pConclusionMavacamten influences diverse facets of HCM comprehensively. Notably, our study delved into the drug's impact on the heart's structural and functional aspects, providing insights that complement prior findings. Further large-scale trials are needed to evaluate the safety profile of Mavacamten

Forest plot showing changes in LVOT at rest of the Mavacamten group compared to placebo at random effect.

Forest plot showing changes in LVOT at rest of the Mavacamten group compared to placebo at random effect.</p

Leave-out analysis with the forest plot showing changes in NT-proBNP of the Mavacamten group compared to placebo at random effect.

Leave-out analysis with the forest plot showing changes in NT-proBNP of the Mavacamten group compared to placebo at random effect.</p

Dataset use to draw results and conclusions.

BackgroundHypertrophic Cardiomyopathy (HCM) is a complex cardiac condition characterized by hypercontractility of cardiac muscle leading to a dynamic obstruction of left ventricular outlet tract (LVOT). Mavacamten, a first-in-class cardiac myosin inhibitor, is increasingly being studied in randomized controlled trials. In this meta-analysis, we aimed to analyse the efficacy and safety profile of Mavacamten compared to placebo in patients of HCM.MethodWe carried out a comprehensive search in PubMed, Cochrane, and clinicaltrials.gov to analyze the efficacy and safety of mavacamten compared to placebo from 2010 to 2023. To calculate pooled odds ratio (OR) or risk ratio (RR) at 95% confidence interval (CI), the Mantel-Haenszel formula with random effect was used and Generic Inverse Variance method assessed pooled mean difference value at a 95% CI. RevMan was used for analysis. PResultsWe analyzed five phase 3 RCTs including 609 patients to compare mavacamten with a placebo. New York Heart Association (NYHA) grade improvement and KCCQ score showed the odds ratio as 4.94 and 7.93 with pConclusionMavacamten influences diverse facets of HCM comprehensively. Notably, our study delved into the drug’s impact on the heart’s structural and functional aspects, providing insights that complement prior findings. Further large-scale trials are needed to evaluate the safety profile of Mavacamten.</div

Risk of bias of included studies in the meta-analysis.

Risk of bias of included studies in the meta-analysis.</p

Forest plot showing changes in Cardiac troponin-I of the Mavacamten group compared to placebo at random effect.

Forest plot showing changes in Cardiac troponin-I of the Mavacamten group compared to placebo at random effect.</p

Leave-out analysis with the forest plot showing changes in Cardiac troponin-I of the Mavacamten group compared to placebo at random effect.

Leave-out analysis with the forest plot showing changes in Cardiac troponin-I of the Mavacamten group compared to placebo at random effect.</p

Forest plot showing changes in LVOT at post-exercise of Mavacamten compared to placebo at random effect.

Forest plot showing changes in LVOT at post-exercise of Mavacamten compared to placebo at random effect.</p

Forest plot showing NYHA grade improvement in the Mavacamten group compared to placebo at random effect.

Forest plot showing NYHA grade improvement in the Mavacamten group compared to placebo at random effect.</p

Forest plot showing changes in LAVI of the Mavacamten group compared to placebo at random effect.

Forest plot showing changes in LAVI of the Mavacamten group compared to placebo at random effect.</p