METEORIC-HF
Trial question
What is the effect of omecamtiv mecarbil, a novel cardiac myosin activator, in patients with chronic HFrEF?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
15.0% female
85.0% male
N = 276
276 patients (42 female, 234 male)
Inclusion criteria: patients with chronic HFrEF
Key exclusion criteria: major medical event or procedure within the previous 3 months; conditions limiting exercise capacity during exercise testing; inability to achieve a respiratory exchange ratio ≥ 1.05 on baseline cardiopulmonary exercise testing
Interventions
N=185 omecamtiv mecarbil (a dose of 25 mg, 37.5 mg, or 50 mg based on target plasma levels for 20 weeks)
N=91 placebo (matching placebo)
Primary outcome
Improvement in exercise capacity after 20 weeks of therapy
-0.24
0.21
0.2 mL/kg/...
0.1 mL/kg/...
0.1 mL/kg/...
0.0 mL/kg/...
-0.1 mL/kg/...
-0.1 mL/kg/...
-0.2 mL/kg/...
-0.2 mL/kg/...
Omecamtiv
mecarbil
Placebo
No significant
difference ↔
No significant difference in improvement in exercise capacity after 20 weeks of therapy (-0.24 mL/kg/min vs. 0.21 mL/kg/min; AD -0.45 mL/kg/min, 95% CI -1.02 to 0.13)
Secondary outcomes
No significant difference in improvement in ventilatory efficiency (0.28 vs. -0.14 ; AD 0.41 , 95% CI -0.8 to 1.6)
No significant difference in improvement in total daily activities by actigraphy (-0.2 vs. -0.5 ; AD 0.3 , 95% CI -0.6 to 1.1)
Significant decrease in improvement in peak workload achieved (-3.8 W vs. 1.6 W; AD -5.4 W, 95% CI -10.1 to -0.7)
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with chronic HFrEF, omecamtiv mecarbil was not superior to placebo with respect to improvement in exercise capacity after 20 weeks of therapy.
Reference
Gregory D Lewis, Adriaan A Voors, Alain Cohen-Solal 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):259-269.
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