Core Insights - Cytokinetics, Incorporated's shares increased by 40.4% on September 2 due to positive results from a phase III study of cardiovascular candidate aficamten [1] - The MAPLE-HCM study results were presented at the European Society of Cardiology Congress 2025 and published in The New England Journal of Medicine [1][2] Study Overview - The MAPLE-HCM study is a phase III randomized, double-blind, active-comparator clinical trial comparing aficamten to metoprolol in patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) [3] - Aficamten is a selective, small molecule cardiac myosin inhibitor, while metoprolol is a standard beta-blocker [3] Study Results - The study enrolled 175 patients, randomized to receive either aficamten or metoprolol as monotherapy [4] - Aficamten demonstrated superiority over metoprolol on all clinically relevant efficacy endpoints, with a mean change in peak oxygen uptake (pVO2) of +1.1 mL/kg/min for aficamten compared to -1.2 mL/kg/min for metoprolol after 24 weeks [5] - The primary endpoint showed a statistically significant least-squares mean difference of 2.3 mL/kg/min between the two groups [6] - Aficamten also outperformed metoprolol in five of six secondary endpoints, improving exercise capacity, symptoms, and left ventricular outflow tract (LVOT) gradients [9] Patient Outcomes - 51% of patients receiving aficamten showed improvement in functional class compared to 26% for metoprolol [10] - Aficamten significantly improved resting LVOT gradient and Valsalva LVOT-G, with minimal reduction in left ventricular ejection fraction (LVEF) [10] Additional Data - Aficamten improved cardiac structure and function compared to metoprolol, with an annual incidence rate of atrial fibrillation at 1.5% [12] - Long-term data were consistent with the previously reported safety profile of aficamten [12] Regulatory Status - Aficamten is under FDA review, with a target decision date set for December 26, 2025 [8][13] - The FDA extended the target action date due to the submission of a Risk Evaluation and Mitigation Strategy (REMS) [14][15] Competitive Landscape - Upon approval, aficamten will compete with Camzyos (mavacamten), a first-in-class cardiac myosin inhibitor already approved by the FDA [16]

Summary of Conference Call on Aficamtan and MAPLE HCM Study Company and Industry - **Company**: Cytokinetics - **Industry**: Cardiovascular Pharmaceuticals, specifically focusing on treatments for obstructive hypertrophic cardiomyopathy (HCM) Key Points and Arguments Overview of Aficamtan and MAPLE HCM Study - Aficamtan is a cardiac myosin inhibitor aimed at treating obstructive hypertrophic cardiomyopathy (OHCM) [7][9] - The MAPLE HCM study is a Phase III clinical trial comparing aficamtan to the standard beta blocker metoprolol in patients with OHCM [8][17] - The study demonstrated that aficamtan improved exercise capacity, while metoprolol resulted in a decrease in exercise capacity [9][21] Study Results - Aficamtan showed a statistically significant mean increase in peak VO2 of 1.1 mL/kg/min compared to a decrease of 1.2 mL/kg/min in the metoprolol group, with a mean difference of 2.3 mL/kg/min (p < 0.001) [21] - Secondary endpoints, including improvements in symptoms, NT proBNP levels, and left atrial volume index, were statistically significant in favor of aficamtan [22][24] - Aficamtan was well tolerated, with fewer patients needing to discontinue treatment due to adverse events compared to metoprolol [25][26] Clinical Implications - The results challenge the long-standing use of beta blockers as the first-line treatment for symptomatic OHCM, suggesting aficamtan may be a superior option [9][27] - The study highlights the need for updated clinical guidelines to reflect the new evidence supporting aficamtan as a first-line therapy [76][78] Expert Perspectives - Experts expressed that the findings from MAPLE HCM were groundbreaking, indicating that beta blockers may not be as effective as previously thought [31][34] - The excitement at the European Society of Cardiology (ESC) congress was palpable, with many attendees recognizing the significance of the trial results [32][33] Future Directions - Cytokinetics is preparing to submit a supplemental NDA to include MAPLE HCM results in the labeling of aficamtan following its potential approval [80] - The company anticipates sharing results from the ongoing Acacia HCM study in 2026, which will further inform the treatment landscape for HCM [81] Other Important Content - The call included discussions on the implications of the results for non-obstructive HCM and the challenges faced in clinical trials for this population [56][60] - The panelists emphasized the importance of individualized treatment approaches and the need for further research to understand the mechanisms underlying non-obstructive HCM [70][72] This summary encapsulates the critical findings and discussions from the conference call regarding aficamtan and its implications for the treatment of obstructive hypertrophic cardiomyopathy.

Cytokinetics (CYTK) Update Summary Company Overview - **Company**: Cytokinetics (CYTK) - **Focus**: Development of aficamtan for the treatment of obstructive hypertrophic cardiomyopathy (OHCM) Key Industry Insights - **Industry**: Cardiovascular Medicine - **Event**: European Society of Cardiology (ESC) Conference Core Findings from the Call 1. **Presentation of Data**: Cytokinetics presented four oral presentations and one poster on aficamtan, with three publications in leading cardiac journals, emphasizing its potential as a treatment for OHCM [7][8][27] 2. **MAPLE HCM Study**: The Phase III trial compared aficamtan to metoprolol, showing aficamtan's superiority in improving exercise capacity and reducing symptoms [8][26] 3. **Efficacy Results**: - Aficamtan showed a mean increase in peak VO2 of 1.1 mL/kg/min, while metoprolol showed a mean decrease of 1.2 mL/kg/min, with a statistically significant difference of 2.3 mL/kg/min (p < 0.001) [21][26] - Aficamtan improved NT proBNP levels by 81% compared to baseline, while metoprolol's levels increased [24][26] 4. **Safety Profile**: Aficamtan was well tolerated with a low incidence of adverse events, contrasting with metoprolol, which had a higher rate of dose reductions due to side effects [25][26] 5. **Long-term Data**: Data from FORWEST HCM indicated sustained hemodynamic benefits and low incidence of new onset atrial fibrillation over a mean follow-up of 62 weeks [11][12] Implications for Treatment 1. **Shift in Treatment Paradigm**: The results challenge the long-standing use of beta blockers as first-line therapy for symptomatic obstructive HCM, suggesting aficamtan as a more effective alternative [8][31] 2. **Guideline Updates**: Anticipation of updates to clinical guidelines to incorporate findings from MAPLE HCM and other studies, with a focus on aficamtan as a first-line therapy [77][79] Additional Insights 1. **Expert Perspectives**: Panelists highlighted the importance of randomized clinical trials in reshaping treatment approaches and the surprising underperformance of beta blockers in the study [33][36] 2. **Future Studies**: Ongoing studies, including Acacia HCM, are expected to provide further insights into the efficacy of aficamtan in different patient populations [82] 3. **Regulatory Pathway**: Cytokinetics is preparing a supplemental NDA to include MAPLE HCM results in labeling following the potential approval of aficamtan [81][82] Conclusion - The data presented at the ESC conference significantly bolster the case for aficamtan as a first-line treatment for obstructive HCM, potentially leading to a paradigm shift in clinical practice and future treatment guidelines [26][31][81]