Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure

This phase 3 randomized trial (GALACTIC-HF) evaluated omecamtiv mecarbil, a selective cardiac myosin activator, in patients with symptomatic chronic heart failure and a reduced ejection fraction (≤35%). A total of 8256 patients were assigned to omecamtiv mecarbil (PK-guided doses of 25, 37.5, or 50 mg BID) or placebo alongside standard therapy. Over a median follow-up of 21.8 months, the primary composite outcome—first heart failure event or cardiovascular death was modestly reduced in the omecamtiv group (HR 0.92; 95% CI 0.86–0.99; P=0.03). However, there was no significant reduction in cardiovascular death or all-cause mortality. NT-proBNP levels declined, and cardiac troponin I levels slightly increased. Rates of myocardial ischemia, ventricular arrhythmias, and stroke were similar between groups. The findings support omecamtiv mecarbil as a potential adjunct for lowering hospitalization risks in systolic heart failure, with neutral effects on survival endpoints.

This phase 3 randomized trial (GALACTIC-HF) evaluated omecamtiv mecarbil, a selective cardiac myosin activator, in patients with symptomatic chronic heart failure and a reduced ejection fraction (≤35%). A total of 8256 patients were assigned to omecamtiv mecarbil (PK-guided doses of 25, 37.5, or 50 mg BID) or placebo alongside standard therapy. Over a median follow-up of 21.8 months, the primary composite outcome—first heart failure event or cardiovascular death was modestly reduced in the omecamtiv group (HR 0.92; 95% CI 0.86–0.99; P=0.03). However, there was no significant reduction in cardiovascular death or all-cause mortality. NT-proBNP levels declined, and cardiac troponin I levels slightly increased. Rates of myocardial ischemia, ventricular arrhythmias, and stroke were similar between groups. The findings support omecamtiv mecarbil as a potential adjunct for lowering hospitalization risks in systolic heart failure, with neutral effects on survival endpoints.