| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Hypertrophic Cardiomyopathy |
|
| E.1.1.1 | Medical condition in easily understood language |
Inherited heart disease causing thickening of the muscle wall of the
heart |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 20.0 |
| E.1.2 | Level | PT |
| E.1.2 | Classification code | 10020871 |
| E.1.2 | Term | Hypertrophic cardiomyopathy |
| E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
|
| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
| • To assess the long-term safety and tolerability of mavacamten in participants with HCM previously enrolled in 1 of 2 placebo-controlled trials: MAVERICK-HCM for nHCM and EXPLORER-HCM for oHCM. |
|
| E.2.2 | Secondary objectives of the trial |
• To assess in the MAVERICK-LTE and EXPLORER-LTE cohorts the long-term effects of mavacamten on symptoms and echocardiographic measures of cardiac function
• To assess LVOT obstruction as determined by Doppler echocardiography in the EXPLORER-LTE cohort |
|
| E.2.3 | Trial contains a sub-study | Yes |
| E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Cardiac Magnetic Resonance Imaging Substudy - To assess the long-term effects of mavacamten on cardiac mass and structure as evaluated by cardiac magnetic resonance imaging (CMR)
MAVERICK-LTE Participants
At selected qualified sites, eligible participants will have the option to participate in the CMR substudy. It is anticipated that up to 40 participants will be enrolled. In addition to the main study schedule of procedures, participants will undergo CMR at Day 1 (predose; within 5
days prior to dosing) and at subsequent CMR visits (± 5 days of the
scheduled visits).
EXPLORER-LTE Participants
At selected qualified sites, eligible individuals who participated in the EXPLORER-HCM CMR substudy will have the option to continue their participation; up to 80 participants will be enrolled. In addition to the main study schedule of procedures, these participants will undergo CMR assessments (± 5 days of the
scheduled visits).
|
|
| E.3 | Principal inclusion criteria |
1. Has completed the Parent Study through to the EOS Visit within 90 days of signing consent. (Participants who are beyond the 90 day window from EOS Visit may be included in this study pending MyoKardia Medical Monitor approval). .Participants who prematurely discontinued
from the Parent Study or the MAVA LTE study may be considered for
inclusion.
2. Is able to understand and comply with the study procedures, understand the risks involved in the study, and provide informed consent according to federal, local, and institutional guidelines before the first study-specific procedure
3. Body weight is greater than 45 kg at the Screening Visit or Day 1 (Day 1 weight must be verified prior to dosing)
4. Has adequate acoustic windows to enable accurate TTEs (refer to Echocardiography Site Instruction Manual)
5. Has documented LVEF ≥ 50% by echocardiography core laboratory read of screening TTE at rest
6. Has safety laboratory parameters within normal limits (according to the central laboratory reference range); however, a participant with safety laboratory parameters outside normal limits may be included if he or she meets all of the following criteria:
• The safety laboratory parameter outside normal limits is considered by the Investigator to be clinically unimportant
• If there is an alanine aminotransferase or aspartate aminotransferase result, the value must be < 3× the upper limit of the laboratory reference range
• The body size–adjusted estimated glomerular filtration rate is ≥ 30 mL/min/1.73 m2
7. Female participants must not be pregnant or lactating and, if sexually active, must use one of the following highly effective birth control methods from the Screening Visit through 4 months after the last dose of investigational medicinal product (IMP).
• combined (estrogen- and progestogen-containing) hormonal contraception associated with inhibition of ovulation or progestogen-only hormonal contraception associated with inhibition of ovulation by oral, implantable, or injectable route of administration
• intrauterine device (IUD)
• intrauterine hormone-releasing system (IUS)
• bilateral tubal occlusion
• Female is surgically sterile for 6 months or postmenopausal for 1 year. Permanent sterilization includes hysterectomy, bilateral oophorectomy, bilateral salpingectomy, and/or documented bilateral tubal occlusion at least 6 months prior to Screening. Females are considered postmenopausal if they have had amenorrhea for at least 1 year or more following cessation of all exogenous hormonal treatments and follicle stimulating hormone levels are in the postmenopausal range.
• In addition to the above contraceptive requirements for female participants, male partners must also use a contraceptive (eg, barrier, condom, or vasectomy) |
|
| E.4 | Principal exclusion criteria |
1. Has persistent or permanent atrial fibrillation not on anticoagulation for at least 4 weeks prior and/or is not adequately rate-controlled
(Note: participants with persistent or permanent atrial fibrillation who are anticoagulated and adequately rate-controlled are allowed)
2. Is currently taking, or has taken within 14 days of Screening, a prohibited medication such as a cytochrome P450 (CYP) 2C19 inhibitor (eg, omeprazole), a strong CYP 3A4 inhibitor, or St. John’s Wort (see APPENDIX 2 for more details)
3. Has QTcF > 500 ms at Screening or any other ECG abnormality considered by the Investigator to pose a risk to participant safety (eg, second degree atrioventricular block type II)
4. Has documented obstructive coronary artery disease (> 70% stenosis in one or more epicardial coronary arteries) or history of myocardial infarction
5. Has known moderate or severe (as per Investigator’s judgment) aortic valve stenosis at Screening Visit
6. Has hypersensitivity to any of the components of the mavacamten formulation
7. Has participated in a clinical trial in which the participant received
any investigational drug (or is currently using an investigational device)
within 30 days prior to Screening, or at least 5 times the respective
elimination half life (whichever is longer), except for participation in
MAVERICK-HCM or EXPLORER-HCM. Prior participation in a noninterventional observational study is
allowed.
8. Has a history of syncope or a history of sustained ventricular tachyarrhythmia with exercise between Parent Study EOS Visit and Screening Visit.
9. Has a history of resuscitated sudden cardiac arrest or known history of appropriate implantable cardioverter-defibrillator (ICD) discharge for life-threatening ventricular arrhythmia between Parent Study EOS Visit and Screening Visit.
(Note: history of anti-tachycardia pacing (ATP) is allowed)
10. Currently treated with disopyramide or ranolazine (within 14 days prior to Screening Visit) or treatment with disopyramide or ranolazine is planned during the study
11. Currently treated or planned treatment during the study with a combination of beta blocker and verapamil or a combination of beta blocker and diltiazem
12. Has any acute or serious comorbid condition (eg, major infection or hematologic, renal, metabolic, gastrointestinal, or endocrine dysfunction) that, in the judgment of the Investigator, could lead to premature termination of study participation or interfere with the measurement or interpretation of the efficacy and safety assessments in the study
13. History of clinically significant malignant disease that developed since enrollment in the Parent Study
• Participants who have been successfully treated for nonmetastatic cutaneous squamous cell or basal cell carcinoma or have been adequately treated for cervical carcinoma in situ or breast ductal carcinoma in situ can be included in the study
14. Is unable to comply with the study requirements, including the number of required visits to the clinical site
15. Is employed by or is a relative of someone employed by MyoKardia, the Investigator, or his/her staff or family |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
Safety
· Incidence of major adverse cardiac events (death, stroke, acute myocardial infarction)
· Incidence of hospitalizations (both cardiovascular [CV] and non‑CV)
· Incidence of heart failure (HF) events (includes HF hospitalizations and urgent emergency room/outpatient visits for HF)
· Incidence of atrial fibrillation/flutter (new from Screening Visit)
· Incidence of ICD therapy and resuscitated cardiac arrest
· Incidence of ventricular tachyarrhythmias (includes ventricular tachycardia, or ventricular fibrillation)
· Incidence of any AE potentially linked to QT prolongation (Torsade de pointes, CV or sudden death, sustained ventricular tachycardia, ventricular fibrillation and flutter, syncope, and seizures)
· Frequency and severity of treatment-emergent AEs, treatment-emergent serious AEs, and laboratory abnormalities (including trends in NT-proBNP)
Efficacy and Pharmacodynamics
· Change from baseline in echo parameters of systolic function (eg, LVEF) and diastolic function (eg, peak velocity of early diastolic septal and lateral mitral annular motion [eꞌ], ratio of peak velocity of early diastolic transmitral flow [E] to eꞌ [E/eꞌ], ratio of E to peak velocity of late transmitral flow [A] [E/A], pulmonary artery systolic pressure, or left atrium size) over time
· Change from baseline in resting and post-Valsalva LVOT gradient (EXPLORER-HCM participants only)
· Change from baseline in New York Heart Association functional class over time
· Change from baseline in NT-proBNP over time
· Frequency of cardiac transplantation
Exploratory
· Change from baseline in arterial pulse wave morphology assessed using an optical biosensor (MAVERICK-HCM participants only)
· Change from baseline over time in participant-reported severity of HCM symptoms as assessed by the hypertrophic cardiomyopathy symptom questionnaire (HCMSQ) score (EXPLORER-HCM participants only)
· Change from baseline in health status as assessed by the EQ-5D-5L scores (EXPLORER-HCM participants only)
Pharmacokinetics
· PK parameters using a population PK approach
|
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
1 Over time, up to week 252/EOT
2 Over time, up to week 252/EOT
3 Over time, up to week 252/EOT
4 Over time, up to week 252/EOTT
5 Over time, up to week 252/EOT |
|
| E.5.2 | Secondary end point(s) |
CMR Substudy -
For Participants from EXPLORER-HCM
• Change from Week 24 in myocardial fibrosis as measured by late gadolinium enhancement
• Change from Week 24 in cellular hypertrophy, left atrial volume and function, and LV function
For Participants from MAVERICK-HCM
• Change from baseline in myocardial fibrosis as measured by late gadolinium enhancement
• Change from baseline in cellular hypertrophy, left atrial volume and function, and LV function |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | Yes |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | Yes |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
| E.7.4 | Therapeutic use (Phase IV) | No |
| E.8 Design of the trial |
| E.8.1 | Controlled | No |
| E.8.1.1 | Randomised | No |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | Information not present in EudraCT |
| E.8.1.4 | Double blind | Information not present in EudraCT |
| E.8.1.5 | Parallel group | Information not present in EudraCT |
| E.8.1.6 | Cross over | Information not present in EudraCT |
| E.8.1.7 | Other | Information not present in EudraCT |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
| E.8.2.2 | Placebo | Information not present in EudraCT |
| E.8.2.3 | Other | Information not present in EudraCT |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 51 |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
| Belgium |
| Czechia |
| Denmark |
| France |
| Germany |
| Israel |
| Italy |
| Netherlands |
| Poland |
| Portugal |
| Spain |
| United Kingdom |
| United States |
|
| E.8.7 | Trial has a data monitoring committee | Yes |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 3 |
| E.8.9.1 | In the Member State concerned months | 8 |
| E.8.9.1 | In the Member State concerned days | 12 |
| E.8.9.2 | In all countries concerned by the trial years | 5 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |
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