Outcomes of a Multidisciplinary Approach to Management of Mavacamten in Obstructive Hypertrophic Cardiomyopathy

Abstract

AbstractBackgroundTraditional treatments for obstructive hypertrophic cardiomyopathy (oHCM) include beta-blockers, calcium channel blockers, and disopyramide. Mavacamten, a novel cardiac myosin inhibitor, is a promising oHCM therapy but has practical challenges limiting its use. This study aimed to describe a clinic workflow for mavacamten management in a real-world setting, addressing challenges such as cost, drug interactions, and monitoring requirements. The focus was on reducing patient-level costs while ensuring feasibility and efficiency.MethodsA retrospective analysis was conducted on 34 oHCM patients considered for mavacamten between May 2022 and May 2023. The clinic workflow involved cardiologist assessment, pharmacist evaluation of drug interactions, enrollment in the mavacamten REMS program, cost reduction measures, and initiation monitoring through scheduled echocardiograms. An algorithm detailing steps and tools used in this workflow is provided.ResultsOf the 34 patients, 21 (62%) were initiated on mavacamten and followed for up to 1 year on therapy. Cost assessments indicated reduced out-of-pocket expenses with assistance programs. The median time from referral to first fill was 22 days. Patients demonstrated high adherence (99.1%) measured by proportion of days covered. Echocardiogram follow-ups showed significant improvements in left ventricular outflow tract parameters with no patients having a decrease in left ventricular ejection fraction to less than 50%.ConclusionsThe described workflow effectively addressed challenges associated with mavacamten management, emphasizing roles for clinic personnel, cost reduction strategies, and structured patient monitoring. While the workflow’s specifics may need adaptation in different settings, this report provides valuable insights for clinics implementing structured mavacamten management approaches.