Outcomes of a multidisciplinary approach to management of mavacamten in obstructive hypertrophic cardiomyopathy

Abstract

Purpose: Traditional treatments for obstructive hypertrophic cardiomyopathy (oHCM) include β-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 descriptive 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.

Summary: A retrospective analysis was conducted on 34 patients with oHCM for whom mavacamten was considered between May 2022 and May 2023. The clinic workflow involved cardiologist assessment, pharmacist evaluation of drug interactions, enrollment in the mavacamten risk evaluation and mitigation strategy program, cost reduction measures, and initiation of monitoring through scheduled echocardiograms. Of the 34 patients, 21 (62%) were initiated on mavacamten and followed for up to 1 year on therapy. The median time from referral to prior authorization approval and first fill was 5 and 22 days, respectively. Patients demonstrated high adherence (99.1%) as measured by the proportion of days covered. Echocardiogram follow-up showed improvements in left ventricular outflow tract parameters with no patients having a decrease in left ventricular ejection fraction to less than 50%.

Conclusion: The 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.

Keywords: MYK-461; hypertrophic cardiomyopathy; patient care team; workflow.