24. OMECAMTIVE MECARBIL, A NOVEL THERAPEUTIC AGENT FOR HEART FAILURE WITH REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW

Abstract

Background: At least half of the millions of heart failure patients have heart failure with reduced ejection fraction (HFrEF). There have been many drugs used to treat heart failure, but these drugs don’t directly work on the target pathogenesis of HFrEF. Improving systolic function will prevent neurohormonal activation and ventricular remodeling, which clinically will provide better results from hospitalization and causes of death. Omecamtive mecarbil (OM) is a novel selective cardiac myosin activator, it will improve cardiac function in patients with HFrEF. Objective: We aim to assess the latest evidence on the outcome of OM in heart failure patients. Method: We performed a comprehensive search on topics that assesses OM outcomes in heart failure patients from inception up until January 2021. Results: There were 17.712 HFrEF patients from six studies. Three studies showed the decrease of heart rate, two studies prove that OM increase the stroke volume and systolic ejection time, while each of one study showed increase of left ventricular ejection fraction and decrease left ventricular end systolic volume, left ventricular end diastolic volume, left ventricular fraction shortening, left ventricular end systolic dimension and left ventricular end diastolic dimension from the baseline. The route via intravena maximum tolerated by dose 0,5 mg/kg per h, while via orally start with dose 25 mg twice daily. No significant side effects were found. One randomized controlled trial study also showed a lower risk of a composite heart failure events and cardiovascular death than those who received placebo. Conclusion: Omecamtive mecarbil improved cardiac function in heart failure and could be the first in class of a new therapeutic agent. Further controlled studies are warranted for definite conclusion.