E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Symptomatic Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction |
Cardiomiopatia ipertrofica sintomatica e ostruzione del tratto di efflusso ventricolare sinistro |
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E.1.1.1 | Medical condition in easily understood language |
A kind of heart disease with enlarging of the heart and the obstruction of a cardiac tract |
Un tipo di cardiopatia con ingrossamento del cuore e ostruzione di un tratto cardiaco |
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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 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the safety and tolerability of MYK-224 in participants with oHCM (obstructive hypertrophic cardiomyopathy) |
Valutare la sicurezza e la tollerabilità di MYK-224 in partecipanti con oHCM (cardiomiopatia ipertrofica ostruttiva) |
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E.2.2 | Secondary objectives of the trial |
- To evaluate the effect of MYK-224 on LVOT gradient in participants with oHCM - To assess the PK/PD relationship of MYK-224 - To assess the PK of MYK-224 in participants with oHCM |
- Valutare l’effetto di MYK-224 sul gradiente del tratto di efflusso del ventricolo sinistro (LVOT) in partecipanti con oHCM - Valutare la relazione PK/PD di MYK-224 - Valutare la PK di MYK-224 in partecipanti con oHCM |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Has adequate acoustic windows, to enable accurate TTEs as determined by the echocardiography core laboratory. - Men or women diagnosed with oHCM consistent with current American College of Cardiology Foundation/American Heart Association and European Society of Cardiology guidelines, satisfying both of the following criteria: -- Has unexplained left ventricular (LV) hypertrophy with nondilated ventricular chambers in the absence of other cardiac (eg, hypertension, aortic stenosis) or systemic disease and with maximal LV wall thickness >= 15 millimeter (mm) (or >= 13 mm with positive family history of hypertrophic cardiomyopathy or with a known disease-causing mutation), as determined by core laboratory interpretation. AND -- Has a LVOT peak gradient during screening as assessed by echocardiography of >= 50 millimeters of mercury (mm Hg) at rest, or >= 30 mm Hg at rest and >= 50 mm Hg after Valsalva maneuver (confirmed by echocardiography core laboratory interpretation). - Has documented LVEF >= 60% at the Screening visit as determined by echocardiography core laboratory. - Has a valid measurement of LVOT post-exercise peak gradient at screening as determined by echocardiography core laboratory. - NYHA functional class II or III symptoms at screening. |
- Dispone di finestre acustiche adeguate, per consentire ecocardiogrammi transtoracici (TTE) accurati, come determinato dal laboratorio centrale di ecocardiografia. - Uomini o donne con diagnosi di cardiomiopatia ipertrofica ostruttiva (oHCM) coerente con le attuali linee guida dell’American College of Cardiology Foundation/American Heart Association e della European Society of Cardiology che soddisfano entrambi i seguenti criteri: -- Presenta ipertrofia ventricolare sinistra (VS) inspiegabile con camere ventricolari non dilatate in assenza di altre patologie cardiache (ad es. ipertensione, stenosi aortica) o sistemiche e con spessore massimo della parete VS >= 15 millimetri (mm) (o >= 13 mm con anamnesi familiare positiva di cardiomiopatia ipertrofica o con una mutazione nota che causa la malattia), come determinato dall’interpretazione del laboratorio centrale. E -- Presenta un gradiente di picco del tratto di efflusso ventricolare sinistro (LVOT) durante lo screening valutato mediante ecocardiografia di >= 50 millimetri di mercurio (mm Hg) a riposo o >= 30 mm Hg a riposo e >= 50 mm Hg dopo la manovra di Valsalva (confermata dall’interpretazione dell’ecocardiografia del laboratorio centrale). - Presenta una FEVS (frazione di eiezione ventricolare sinistra) documentata >= 60% alla visita di screening, come determinato dal laboratorio centrale di ecocardiografia. - Presenta una misurazione valida del gradiente di picco LVOT post-esercizio allo screening, come determinato dal laboratorio centrale di ecocardiografia. - Sintomi di classe funzionale della New York Heart Association (NYHA) II o III allo screening. |
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E.4 | Principal exclusion criteria |
- Presence of any medical condition that precludes exercise stress testing. - History of syncope or sustained ventricular tachyarrhythmia within 6 months prior to screening. - Known infiltrative or storage disorder causing cardiac hypertrophy that mimics HCM, such as Fabry disease, amyloidosis, or Noonan syndrome with left ventricular hypertrophy. - Has been successfully treated with invasive septal reduction (surgical myectomy or percutaneous alcohol septal ablation [ASA]) within 6 months prior to Screening or plans to have either of these treatments during the study (Note: Individuals with an unsuccessful myectomy or percutaneous ASA procedure performed > 6 months prior to Screening may be enrolled if study eligibility criteria for LVOT gradient criteria are met). - Implantable cardioverter-defibrillator (ICD) placement or pulse generator change within 2 months prior to screening or planned new ICD placement during the study (pulse generator changes, if needed during the study are allowed). - Has a history of resuscitated sudden cardiac arrest (any time) or known history of appropriate implantable cardioverter-defibrillator (ICD discharge for life-threatening ventricular arrhythmia within 6 months prior to screening. - Has paroxysmal, intermittent atrial fibrillation with atrial fibrillation present per the Investigator's evaluation of the subject's ECG at the time of Screening. - Has persistent or permanent atrial fibrillation not on anticoagulation for at least 4 weeks prior to Screening and/or not adequately rate controlled within 6 months prior to Screening. - Has QT interval with Fridericia correction (QTcF) > 500 msec when QRS interval < 120 msec or QTcF > 520 msec when QRS >= 120 msec if participant has left bundle branch block or any other 12-lead ECG abnormality considered by the investigator to pose a risk to participant safety (eg, second-degree atrioventricular block type II). - Has known moderate or severe (per investigator's judgment) aortic valve stenosis at screening. - History of LV systolic dysfunction (LVEF < 45%) at any time during their clinical course. - Has pulmonary disease that limits exercise capacity. - History of obstructive coronary artery disease (stenosis of > 70% of luminal diameter in one or more coronary arteries). - Prior treatment with mavacamten or aficamten. An exception may be made in cases where myosin inhibitor use was not within 4 months of the Screening visit, and with the agreement of both the Investigator and the Sponsor Medical Monitor. - Prior treatment with cardiotoxic agents such as anthracyclines (eg, doxorubicin) or similar. |
- Presenza di qualsiasi condizione medica che precluda il test sotto sforzo. - Anamnesi di sincope o tachiaritmia ventricolare sostenuta nei 6 mesi precedenti lo screening. - Noto disturbo infiltrativo o da accumulo che causa ipertrofia cardiaca simile all’HCM, come la malattia di Fabry, l’amiloidosi o la sindrome di Noonan con ipertrofia ventricolare sinistra. - È stato trattato con successo con riduzione invasiva del setto (miectomia chirurgica o ablazione alcolica del setto [ASA] percutanea) nei 6 mesi precedenti lo screening o prevede di sottoporsi a uno di questi trattamenti durante lo studio (Nota: i soggetti con una procedura di miectomia o ASA percutanea non riuscita eseguita > 6 mesi prima dello screening possono essere arruolati se soddisfano i criteri di idoneità dello studio per i criteri di gradiente LVOT). - Posizionamento di un cardiovertitore-defibrillatore impiantabile (ICD) o cambio del generatore di impulsi nei 2 mesi precedenti lo screening o nuovo impianto di ICD pianificato durante lo studio (sono consentite cambi del generatore di impulsi, se necessari durante lo studio). - Ha un’anamnesi di arresto cardiaco improvviso rianimato (in qualsiasi momento) o anamnesi nota di cardiovertitore-defibrillatore impiantabile appropriato (dimissione con ICD per aritmia ventricolare potenzialmente letale nei 6 mesi precedenti lo screening. - Presenta fibrillazione atriale parossistica intermittente con fibrillazione atriale presente secondo la valutazione dello sperimentatore dell’ECG del soggetto al momento dello screening. - Presenta fibrillazione atriale persistente o permanente senza terapia anticoagulante da almeno 4 settimane prima dello screening e/o con frequenza non adeguatamente controllata entro 6 mesi prima dello screening. - Presenta intervallo QT con correzione di Fridericia (QTcF) > 500 msec quando l’intervallo QRS < 120 msec o QTcF > 520 msec quando il QRS è >=120 msec se il partecipante ha un blocco di branca sinistro o qualsiasi altra anomalia dell’ECG a 12 derivazioni considerata dallo sperimentatore come un rischio per la sicurezza del partecipante (ad es. blocco atrioventricolare di secondo grado di tipo II). - Presenta nota stenosi della valvola aortica, moderata o grave (secondo il giudizio dello sperimentatore) allo screening. - Anamnesi di disfunzione sistolica VS (FEVS < 45%) in qualsiasi momento durante il decorso clinico. - Malattia polmonare che limita la capacità di esercizio. - Anamnesi di coronaropatia ostruttiva (stenosi > 70% del diametro luminale in una o più arterie coronarie). - Precedente trattamento con mavacamten o aficamten. È possibile fare un’eccezione nei casi in cui l’uso dell’inibitore della miosina non sia avvenuto entro 4 mesi dalla visita di screening e con il consenso sia dello sperimentatore sia del responsabile del monitoraggio medico dello Sponsor. - Trattamento precedente con agenti cardiotossici come le antracicline (ad es. doxorubicina) o simili. |
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E.5 End points |
E.5.1 | Primary end point(s) |
- Incidence, severity, and causality of AEs and SAEs - Incidence of symptomatic LVEF < 50% by TTE - Incidence of LVEF <= 30% by TTE - Incidence of MACE, including cardiovascular death, nonfatal stroke, nonfatal myocardial infarction - Incidence of hospitalizations (due to cardiovascular and noncardiovascular events) - Incidence of HF events (including hospitalizations and urgent emergency room/outpatient visits for HF) - Incidence of atrial fibrillation/flutter (new from screening and recurrent) - Incidence of appropriate implantable cardioverter defibrillator therapy and resuscitated cardiac arrest - Incidence of ventricular tachyarrhythmias (includes ventricular tachycardia, ventricular fibrillation, and Torsades de Pointes) - Results of vital signs, physical exams, 12-lead ECG assessments (including HR), and clinical laboratory tests |
- Incidenza, gravità e causalità di AE e SAE - Incidenza di LVEF sintomatica < 50% per TTE (ecocardiogramma transtoracico) - Incidenza di LVEF <= 30% per TTE - Incidenza di MACE, inclusi morte cardiovascolare, ictus non fatale, infarto del miocardio non fatale - Incidenza dei ricoveri (a causa di eventi cardiovascolari e non cardiovascolari) - Incidenza di eventi HF (inclusi ricoveri e visite urgenti al pronto soccorso/ambulatoriali per HF) - Incidenza di fibrillazione/flutter atriale (insorti dopo lo screening e ricorrenti) - Incidenza della terapia appropriata con defibrillatore cardioverter impiantabile e rianimazione da arresto cardiaco - Incidenza di tachiaritmie ventricolari (include tachicardia ventricolare, fibrillazione ventricolare e torsioni di punta) - Risultati di segni vitali, esami obiettivi, valutazioni ECG a 12 derivazioni (inclusa frequenza cardiaca [HR]) e test clinici di laboratorio |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
- Up to 30 days after EOT - Up to EOS - Up to EOS - Up to 30 days after EOT - Up to 30 days after EOT - Up to EOS - Up to EOS - Up to EOS - Up to EOS - Up to EOS |
- Fino a 30 giorno dopo EOT (fine trattamento) - Fino a EOS (fine studio) - Fino a EOS - Fino a 30 giorno dopo EOT - Fino a 30 giorno dopo EOT - Fino a EOS - Fino a EOS - Fino a EOS - Fino a EOS - Fino a EOS |
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E.5.2 | Secondary end point(s) |
- Effect on LVOT gradient - PK/PD relationship - PK concentrations |
- Effetto sul gradiente del LVOT (tratto di efflusso del ventricolo sinistro) - Relazione PK/PD - Concentrazioni farmacocinetiche |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- Up to EOT - Up to EOS - Up to EOS |
- Fino a EOT - Fino a EOS - Fino a EOS |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability |
Tollerabilità |
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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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Studio pilota in aperto |
Open-label, Pilot Study |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 0 |
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 | 14 |
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 | Information not present in EudraCT |
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 |
United States |
Poland |
Spain |
Italy |
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E.8.7 | Trial has a data monitoring committee | No |
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
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End of trial is defined as the last participant last visit or scheduled procedure as shown as in the Schedule of Activities. |
- |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 4 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 4 |