Item 8.01 Other Events.
On November 7, 2022, Cytokinetics, Incorporated (the "Company" or the
"Registrant") announced new data from two additional analyses from GALACTIC-HF
(Global Approach to Lowering Adverse Cardiac Outcomes Through Improving
Contractility in Heart Failure), as well as an analysis of patients hospitalized
for heart failure with reduced ejection fraction (HFrEF) from the Get With The
Guidelines®-Heart Failure Registry, were presented at the American Heart
Association Scientific Sessions 2022 in Chicago, IL.
Reduction in Heart Failure Events for North American Patients Treated with
Omecamtiv Mecarbil in GALACTIC-HF Associated with 26.9% Cost Reduction over
Three Years
Nihar R. Desai, M.D., MPH, Associate Professor of Medicine, Associate Chief,
Cardiovascular Medicine, Yale School of Medicine, Center for Outcomes Research
and Evaluation, presented data from an analysis of the healthcare resource use,
early benefit and costs of hospitalization for North American patients with
heart failure with reduced ejection fraction (HFrEF) treated with omecamtiv
mecarbil in GALACTIC-HF. This analysis included 1,090 (78.6%) North American
patients from GALACTIC-HF matching the criteria of a subgroup of patients
previously identified as being the most likely to benefit from treatment with
omecamtiv mecarbil: those with an ejection fraction (EF) ?30% and who were not
receiving digoxin in the presence of atrial fibrillation at baseline. In this
subgroup, treatment with omecamtiv mecarbil was associated with a reduction in
the risk of the primary composite endpoint of cardiovascular death or first
heart failure event (hazard ratio (HR) 0.80; 95% CI 0.68-0.95; p=0.013) and a
reduction in the risk of first heart failure event (HR 0.81; 95% CI 0.67-0.98;
p=0.027). Treatment with omecamtiv mecarbil also reduced the risk for total
heart failure events (HR 0.76; 95% CI 0.61-0.94; p=0.010; absolute risk
reduction (ARR) 14.2; number needed to treat (NNT) 7), with 44% fewer heart
failure events seen at 30 days (incidence rate ratio (IRR) 0.56, p=0.035), 39%
fewer heart failure events at 90 days (IRR 0.61, p=0.005), and 21% fewer heart
failure events at 3 years (IRR 0.78, p=0.029), with rising ARR over time. The
estimated cost reduction due to heart failure events avoided with omecamtiv
mecarbil averaged $420 per patient at 30 days (38% reduction), $928 per patient
at 90 days (34% reduction), and $6,052 per patient (26.9% reduction) at 3 years,
suggesting that treatment with omecamtiv mecarbil is associated with both a
clinical and economic benefit for patients with HFrEF.
Women Enrolled in GALACTIC-HF Had Lower Quality of Life at Baseline and Lower
Rate of the Primary Outcome; Treatment Benefit from Omecamtiv Mecarbil Did Not
Differ from Men
Maria Pabon Porras, M.D., Cardiovascular Division, Brigham and Women's Hospital
and Harvard Medical School presented data from an analysis from GALACTIC-HF on
sex differences in baseline characteristics, clinical outcomes, efficacy and
safety of omecamtiv mecarbil. Of 8,232 patients enrolled, 1,749 (21.2%) were
women. At baseline, women had lower Kansas City Cardiomyopathy Questionnaire
(KCCQ) scores (male 67.5 ± 24.8, female 62.4 ± 25.9, p<0.001), indicating they
had worse quality of life, and they were less likely to be treated with
guideline recommended medical therapies and devices than men. For both men and
women, KCCQ scores at baseline were highly predictive of incidence rates of the
primary outcome, however, compared to men, women had a 20% lower adjusted risk
of the primary composite endpoint (HR 0.89; 95% CI 0.81-0.97, p=0.01), and had
lower rates of serious adverse events than men. The treatment effect of
omecamtiv mecarbil did not differ between men and women (interaction p=0.68).
Patients with Ejection Fraction ?30% Have Higher Risk of Death, Heart Failure
Hospitalization
Stephen Greene, M.D., Assistant Professor of Medicine, Duke University School of
Medicine, Member, Duke Clinical Research Institute, presented data from an
analysis of 113,348 patients hospitalized for HFrEF from the Get With the
Guidelines®-Heart Failure Registry admitted between 2014-2019. Patients included
in this analysis were hospitalized for a primary diagnosis of HFrEF with EF
?40%, without severe kidney disease, who did not receive heart transplantation
or a ventricular assist device. Among this population, 78,589 (69%) patients had
an EF ?30% and 34,759 (31%) had EF 31-40%. Compared to patients with EF 31-40%,
patients with EF ?30% were younger (68 vs 74 years), more likely to be Black
(29.6% vs 20.2%), more likely to be male (68.9% vs 60.7%), and more likely to
receive guideline directed medical therapy at discharge. Patients with EF ?30%
had a significantly higher risk of death (p<0.001) and heart failure
hospitalization (p<0.001), as well as numerically higher healthcare costs
(p=0.11) and rehospitalizations (p=0.106). Overall, these data suggest that the
two-thirds of patients hospitalized for HFrEF with in the U.S. with EF ?30%,
despite being younger and more likely to be receiving guideline directed medical
therapy, face worse outcomes including higher rates of death
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and hospitalization.
About Omecamtiv Mecarbil
Omecamtiv mecarbil is an investigational, selective, small molecule cardiac
myosin activator, the first of a novel class of myotropes1 designed to directly
target the contractile mechanisms of the heart, binding to and recruiting more
cardiac myosin heads to interact with actin during systole. Omecamtiv mecarbil
is designed to increase the number of active actin-myosin cross bridges during
each cardiac cycle and consequently augment the impaired contractility that is
associated with heart failure with reduced ejection fraction (HFrEF).
Preclinical research has shown that omecamtiv mecarbil increases cardiac
contractility without increasing intracellular myocyte calcium concentrations or
myocardial oxygen consumption.2-4
The development program for omecamtiv mecarbil is assessing its potential for
the treatment of HFrEF. Positive results from GALACTIC-HF, the first Phase 3
clinical trial of omecamtiv mecarbil demonstrated a statistically significant
effect of treatment with omecamtiv mecarbil to reduce risk of the primary
composite endpoint of cardiovascular (CV) death or heart failure events (heart
failure hospitalization and other urgent treatment for heart failure) compared
to placebo in patients treated with standard of care. No reduction in the
secondary endpoint of time to CV death was observed. Adverse events and
treatment discontinuation of study drug were balanced between treatment arms.
About Heart Failure
Heart failure is a grievous condition that affects more than 64 million people
worldwide5 about half of whom have reduced left ventricular function.6,7 It is
the leading cause of hospitalization and readmission in people age 65 and
older.8,9 Despite broad use of standard treatments and advances in care, the
prognosis for patients with heart failure is poor.10 An estimated one in five
people over the age of 40 are at risk of developing heart failure, and
approximately 50 percent of people diagnosed with heart failure will die within
five years of initial hospitalization.11,12 More than 2 million people in the
U.S. are estimated to have an ejection fraction <30%, indicating they may have
severe heart failure.13
About Cytokinetics
Cytokinetics is a late-stage biopharmaceutical company focused on discovering,
developing and commercializing first-in-class muscle activators and
next-in-class muscle inhibitors as potential treatments for debilitating
diseases in which muscle performance is compromised. As a leader in muscle
biology and the mechanics of muscle performance, the company is developing small
molecule drug candidates specifically engineered to impact muscle function and
contractility. Cytokinetics is readying for the potential commercialization of
omecamtiv mecarbil, its cardiac muscle activator, following positive results
from GALACTIC-HF, a large, international Phase 3 clinical trial in patients with
heart failure. Cytokinetics is also developing aficamten, a next-generation
cardiac myosin inhibitor, currently the subject of SEQUOIA-HCM, the Phase 3
clinical trial of aficamten in patients with symptomatic obstructive
hypertrophic cardiomyopathy (HCM). Aficamten is also being evaluated in
non-obstructive HCM in Cohort 4 of the Phase 2 clinical trial, REDWOOD-HCM.
Cytokinetics is also developing reldesemtiv, an investigational fast skeletal
muscle troponin activator, currently the subject of COURAGE-ALS, a Phase 3
clinical trial in patients with amyotrophic lateral sclerosis (ALS).
Cytokinetics continues its over 20-year history of pioneering innovation in
muscle biology and related pharmacology focused to diseases of muscle
dysfunction and conditions of muscle weakness.
Forward-Looking Statements
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This press release contains forward-looking statements for purposes of the
Private Securities Litigation Reform Act of 1995 (the "Act"). Cytokinetics
disclaims any intent or obligation to update these forward-looking statements
and claims the protection of the Act's Safe Harbor for forward-looking
statements. Examples of such statements include, but are not limited to,
statements, express or implied, relating to any of our other clinical trials,
including statements relating to the potential benefits of omecamtiv mecarbil
for patients with heart failure with reduced ejection fraction or any particular
patient group with certain characteristics or the actual cost reduction due to
heart failure events for patients treated with omecamtiv mecarbil, and
statements relating to our ability to obtain marketing approval from FDA or any
other regulatory body for omecamtiv mecarbil. Such statements are based on
management's current expectations, but actual results may differ materially due
to various risks and uncertainties, including, but not limited to, potential
difficulties or delays in the development, testing, regulatory approvals for
trial commencement, progression or product sale or manufacturing, or production
of Cytokinetics' drug candidates that could slow or prevent clinical development
or product approval; Cytokinetics' drug candidates may have adverse side effects
or inadequate therapeutic efficacy; the FDA or foreign regulatory agencies may
delay or limit Cytokinetics' ability to conduct clinical trials; Cytokinetics
may be unable to obtain or maintain patent or trade secret protection for its
intellectual property; standards of care may change, rendering Cytokinetics'
drug candidates obsolete; and competitive products or alternative therapies may
be developed by others for the treatment of indications Cytokinetics' drug
candidates and potential drug candidates may target. For further information
regarding these and other risks related to Cytokinetics' business, investors
should consult Cytokinetics' filings with the Securities and Exchange
Commission.
References:
1. Psotka MA, Gottlieb SS, Francis GS et al. Cardiac Calcitropes, Myotropes, and
Mitotropes. JACC. 2019; 73:2345-53.
2. Planelles-Herrero VJ, Hartman JJ, Robert-Paganin J. et al. Mechanistic and
structural basis for activation of cardiac myosin force production by omecamtiv
mecarbil. Nat Commun. 2017;8:190.
3. Shen YT, Malik FI, Zhao X, et al. Improvement of cardiac function by a
cardiac myosin activator in conscious dogs with systolic heart failure. Circ
Heart Fail. 2010; 3: 522-27.
4. Malik FI, Hartman JJ, Elias KA, Morgan BP, Rodriguez H, Brejc K, Anderson RL,
Sueoka SH, Lee KH, Finer JT, Sakowicz R. Cardiac myosin activation: a potential
therapeutic approach for systolic heart failure. Science. 2011 Mar
18;331(6023):1439-43.
5. James et al. GBD 2017 Disease and Injury Incidence and Prevalence
Collaborators. Lancet 2018; 392: 1789-858.
6. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the
Management of Heart failure: A Report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Circulation. 2013;128:e240-e327.
7. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the
diagnosis and treatment of acute and chronic heart failure: The Task Force for
the diagnosis and treatment of acute and chronic heart failure of the European
Society of Cardiology (ESC). Developed with the special contribution of the
Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200.
8. Roger VL. Epidemiology of Heart Failure. Circulation Research.
2013;113:646-659, originally published August 29, 2013. Doi:
10.1161/CIRCRESAHA.113.300268.
9. Kilgore M, Patel HK, Kielhorn A et al. Economic burden of hospitalizations of
Medicare beneficiaries with heart failure. Risk Manag Healthc Policy. 2017; 10:
63-70.
10. Jhund PS, MacIntyre K, Simpson CR, et al. Long-Term Trends in First
Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003.
Circulation. 2009;119:515-523.
11. Benjamin EJ, Virani SS, Callaway CW et al. Heart Disease and Stroke
Statistics-2018 Update: A Report From the American Heart Association.
Circulation. 2018;137:e67-e492.
12. Roger VL, Weston SA, Redfield MM, et al. Trends in Heart Failure Incidence
and Survival in a Community-Based Population. JAMA. 2004;292:344-350.
13. Shannon M. Dunlay, Véronique L. Roger, Susan A. Weston, Ruoxiang Jiang, and
Margaret M. Redfield (Circ Heart Fail. 2012;5:720-726.); Olmsted County
community cohort of HF patients (1984 to 2009).
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