Article
作者: McGrew, Frank A. ; Gardner, Martin ; Dib, Nabil M. ; Pellicori, Pierpaolo ; Owens, Anjali T. ; Moses, John ; Jones, Alonzo E. ; Olivotto, Iacopo ; Katz, Stuart D. ; Afshar, Kia ; Hartleib, Michael C. ; Burke, Michael A. ; Judge, Daniel P. ; Pan, Stephen ; Palomares, Jose Fernando Rodriguez ; Avaca, Horacio A. ; Sinagra, Gianfranco ; Wheeler, Matthew T. ; Lepage, Serge ; Beatrice Musumeci, Maria ; Hinchman, David A. ; Tang, W. H. Wilson ; Maurizio Parato, Vito ; Metra, Marco ; Van Cleemput, Johan ; Angeli, Franca S. ; Gottlieb, Robert L. ; Trevino, Miguel E. ; Castillo, Armando Garcia ; Klapholz, Marc ; LeDoux, John ; Ewald, Gregory A. ; Alfonso Jimenez Diaz, Victor ; Ambrosio, Giuseppe ; Ware, James ; Cadrin-Tourigny, Julia ; Loureyro, Juan ; Garcia-Pavia, Pablo ; Barriales-Villa, Roberto ; Stempien-Otero, April C. ; Martindale, Jeffrey ; Tallaj, Jose A. ; Carlos Castillo Dominguez, Juan ; Lee, Patrice ; Haugaa, Kristina H. ; Hofmeyer, Mark ; Williams, Joshua ; Sheikh, Farooq ; Goldberg, Randal I. ; Davis, Darryl ; Forleo, Cinzia ; Arbustini, Eloisa ; Elliott, Perry ; Botta, Cristian E. ; Hershson, Alejandro R. ; McDonald, Thomas V. ; Vanderheyden, Marc ; Samuel Montes Cruz, Eliud ; Taylor, Matthew R.G. ; Andersen, Kjell ; Li, Huihua ; Coats, Caroline ; Pinto, Yigal ; MacRae, Calum A. ; Ripoll Vera, Tomas V. ; Lakdawala, Neal K. ; Kapoor, Saurabh ; Gimeno Blanes, Juan R. ; Gupta, Dinesh K. ; Priori, Silvia G. ; Toma, Mustafa ; Latif, Farhana ; Pineda, J R. ; Garcia Alvarez, Ana ; Hershberger, Ray
BACKGROUND::LMNA
(
lamin A/C
)-related dilated cardiomyopathy is a rare genetic cause of heart failure. In a phase 2 trial and long-term extension, the selective p38α MAPK (mitogen-activated protein kinase) inhibitor, ARRY-371797 (PF-07265803), was associated with an improved 6-minute walk test at 12 weeks, which was preserved over 144 weeks.
METHODS::
REALM-DCM (NCT03439514) was a phase 3, randomized, double-blind, placebo-controlled trial in patients with symptomatic
LMNA
-related dilated cardiomyopathy. Patients with confirmed
LMNA
variants, New York Heart Association class II/III symptoms, left ventricular ejection fraction ≤50%, implanted cardioverter-defibrillator, and reduced 6-minute walk test distance were randomized to ARRY-371797 400 mg twice daily or placebo. The primary outcome was a change from baseline at week 24 in the 6-minute walk test distance using stratified Hodges-Lehmann estimation and the van Elteren test. Secondary outcomes using similar methodology included change from baseline at week 24 in the Kansas City Cardiomyopathy Questionnaire-physical limitation and total symptom scores, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration. Time to a composite outcome of worsening heart failure or all-cause mortality and overall survival were evaluated using Kaplan-Meier and Cox proportional hazards analyses.
RESULTS::
REALM-DCM was terminated after a planned interim analysis suggested futility. Between April 2018 and October 2022, 77 patients (aged 23–72 years) received ARRY-371797 (n=40) or placebo (n=37). No significant differences (
P
>0.05) between groups were observed in the change from baseline at week 24 for all outcomes: 6-minute walk test distance (median difference, 4.9 m [95% CI, −24.2 to 34.1];
P
=0.82); Kansas City Cardiomyopathy Questionnaire-physical limitation score (2.4 [95% CI, −6.4 to 11.2];
P
=0.54); Kansas City Cardiomyopathy Questionnaire-total symptom score (5.3 [95% CI, −4.3 to 14.9];
P
=0.48); and NT-proBNP concentration (−339.4 pg/mL [95% CI, −1131.6 to 452.7];
P
=0.17). The composite outcome of worsening heart failure or all-cause mortality (hazard ratio, 0.43 [95% CI, 0.11–1.74];
P
=0.23) and overall survival (hazard ratio, 1.19 [95% CI, 0.23–6.02];
P
=0.84) were similar between groups. No new safety findings were observed.
CONCLUSIONS::
Findings from REALM-DCM demonstrated futility without safety concerns. An unmet treatment need remains among patients with
LMNA
-related dilated cardiomyopathy.
REGISTRATION::
URL:
https://classic.clinicaltrials.gov
; Unique Identifiers: NCT03439514, NCT02057341, and NCT02351856.