Mavacamten for Hypertrophic Obstructive Cardiomyopathy

Guideline-Based Positioning

The American Heart Association and American College of Cardiology recommend mavacamten as a Class 1 indication for adult patients with obstructive HCM who have persistent symptoms (NYHA class II-III) despite first-line therapy with beta-blockers or nondihydropyridine calcium channel blockers 1, 2, 3
The American College of Cardiology suggests a treatment algorithm starting with beta-blockers or nondihydropyridine calcium channel blockers as first-line therapy, and adding mavacamten as second-line therapy for adult patients with persistent symptoms 1, 2, 3

Mavacamten improves LVOT gradients, symptoms, and functional capacity in 30-60% of patients with obstructive HCM, as demonstrated in clinical trials 1, 4
The American College of Cardiology notes that mavacamten has demonstrated significant reductions in both resting and post-exercise LVOT gradients, improvement in peak oxygen consumption, reduction in NYHA functional class, and enhanced quality of life scores 1

The American Heart Association recommends mandatory echocardiographic monitoring before initiation and every 4 weeks during treatment with mavacamten to assess LVEF 1
The American College of Cardiology advises that mavacamten is contraindicated in pregnancy due to teratogenic effects, and females of reproductive potential must use effective contraception until 4 months after the last dose 3, 5
The American College of Cardiology notes that LVEF reduction <50% occurs in 5.7% of patients attributable solely to the drug, and treatment should be interrupted if LVEF falls <50% or if clinical status worsens 1, 4

The American College of Cardiology recommends that mavacamten should only be used in adult patients, as it is not approved for pediatric use 1, 2, 4
The American Heart Association advises that mavacamten should be discontinued if persistent systolic dysfunction (LVEF <50%) develops, and consideration should be given to interruption during intercurrent illness that could affect cardiac function 3, 4