Institute of Basic Medical Sciences

PDE9 inhibitor, CRD-740, demonstrated favorable safety pro achieved statistical significance for the trial’s primary endpoint, median increase in plasma cyclic guanosine monophosphate (cGMP) This clinical trial confirms that high levels of PDE9 inhibition lead to increases in cGMP, reflecting increased activation of the myocardial natriuretic peptide (NP) signaling pathway Targeting PDE9 represents a novel approach to activating the NP signaling pathway, a highly validated pathway with established clinical benefits in heart failure Clinical results presented today at the Annual Congress of the Heart Failure Association of the European Society of Cardiology BURLINGTON, Mass.--(BUSINESS WIRE)-- Cardurion Pharmaceuticals, Inc. (“Cardurion”), a clinical-stage biotechnology company developing next-generation therapeutics for the treatment of cardiovascular diseases, today announced the presentation of positive clinical data from CARDINAL‑HF, the first Phase 2 proof-of-concept clinical trial of a phosphodiesterase-9 (PDE9) inhibitor in patients with heart failure. These data were presented today at the Annual Congress of the Heart Failure Association of the European Society of Cardiology taking place on May 11-14 in Lisbon, Portugal. In the CARDINAL-HF Phase 2a trial, CRD-740 met the primary endpoint in patients with heart failure with reduced ejection fraction (HFrEF), demonstrating a statistically significant median increase in plasma cyclic guanosine monophosphate (cGMP) after four weeks of treatment. Plasma cGMP is a biomarker for intracellular cGMP whose levels reflect the activity of the protective myocardial natriuretic peptide (NP) signaling pathway, which has proven clinical benefits in heart failure. CRD-740 was generally well tolerated in the trial. “These very promising data from the first Phase 2 proof-of-concept clinical trial of a PDE9 inhibitor in patients with heart failure represent an important next step in the development of this novel mechanism,” said James Udelson, MD, Chief of Cardiology at Tufts Medical Center and Principal Investigator for the CARDINAL-HF trial. “The results of this trial are impressive, showing robust PDE9 inhibition with significant increases in plasma and urinary cGMP, along with a favorable safety profile, both of which support moving into further clinical testing in heart failure.” “Therapeutic targeting of the NP signaling pathway is precedented by today’s standard of care treatment for patients with heart failure, and PDE9 inhibition represents a new mechanism for activating this pathway to seek improved patient outcomes. Significant unmet needs remain, as heart failure is a prevalent and growing chronic condition that causes significant morbidity and mortality for millions of people,” said Scott D. Solomon, MD, Professor of Medicine at Harvard Medical School. The oral presentation of these results, entitled, “A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study to Assess the Tolerability and Pharmacodynamic Effects of CRD-740, a PDE9 Inhibitor, in Participants with Chronic Heart Failure,” were presented today by James Udelson, M.D., Principal Investigator of CARDINAL-HF and Chief of Cardiology at Tufts Medical Center, in the “Late-Breaking Clinical Trials: Medical Therapy” session at the Annual Congress of the Heart Failure Association of the European Society of Cardiology. Key findings presented include: CRD-740 was generally well-tolerated in patients with HFrEF, a disease representing approximately one-half of patients with chronic heart failure. PDE9 inhibition with CRD-740 achieved statistically significant median increases in plasma cGMP at four weeks, compared to placebo, which was the primary endpoint in the trial. Statistically significant median increases in urinary cGMP were also observed in the patients who received CRD-740, compared to placebo. Increases in cGMP of the magnitude seen in the trial demonstrate that CRD-740 achieves high levels of PDE9 inhibition, which prevents cGMP metabolism by the PDE9 enzyme and leads to increased activation of the NP signaling pathway. Activation of the clinically validated NP signaling pathway has been shown to benefit patients with chronic heart failure in outcome studies with sacubitril/valsartan. These increases in plasma and urinary cGMP were observed in patients who received CRD‑740 with and without background treatment with sacubitril/valsartan, supporting the potential for CRD-740 as a monotherapy, and as a new approach to augment efficacy in the setting of sacubitril/valsartan therapy and to further activate the NP signaling pathway. Based on the results of the CARDINAL-HF Phase 2a trial, Cardurion has launched two Phase 2 clinical trials in 640 patients, including a dose-ranging trial in patients with HFrEF and a proof-of-concept trial in patients with heart failure with preserved ejection fraction (HFpEF). “These findings from Cardurion’s pioneering program in PDE9 support our conviction that PDE9 inhibition presents an important new mechanism for independently targeting and further activating the well-validated NP signaling pathway. The data from this trial suggest that PDE9 inhibition has the potential to provide benefit to patients when administered alone or in combination with guideline directed medical therapy, and ultimately become standard of care for patients with both types of heart failure,” said Peter Lawrence, Chief Executive Officer of Cardurion Pharmaceuticals. “We are delighted to share these clinical results for CRD-740 as our team advances PDE9 inhibition as a novel approach to addressing the unmet needs of patients with chronic heart failure,” said Howard Surks, MD, Chief Medical and Scientific Officer of Cardurion Pharmaceuticals. “We thank our patients and investigators for their partnership and look forward to continuing the development of our PDE9 inhibitors to improve outcomes for patients.” About the CARDINAL-HF clinical trial CARDINAL-HF is the first Phase 2 proof-of-concept trial of a PDE9 inhibitor for the treatment of patients with heart failure. The Phase 2a clinical trial is a randomized, placebo-controlled trial of 60 chronic, stable patients with heart failure with reduced ejection fraction (HFrEF) who were receiving guideline-directed medical therapy (GDMT). The primary endpoints of the trial are safety and tolerability of CRD-740 and changes in plasma cGMP at four weeks, a precedented biomarker for activation of the NP signaling pathway. Other endpoints include changes in urinary cGMP and N-terminal pro b-type natriuretic peptide (NTpro-BNP) and effect of CRD-740 administration on the Kansas City Cardiomyopathy questionnaire (KCCQ), which measures symptoms, physical and social limitations, and quality of life in patients with heart failure. The Executive Committee for the CARDINAL-HF trial includes Dr. James Udelson, Principal Investigator and Chief of Cardiology at Tufts Medical Center; Dr. Scott Solomon, Professor of Medicine at Harvard Medical School; and Dr. John McMurray, Professor of Medical Cardiology and Deputy Director of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow. Drs. Udelson, Solomon and McMurray, along with Dr. Eugene Braunwald, the Distinguished Hersey Professor of Medicine at Harvard Medical School, also lead Cardurion’s Clinical Advisory Board. The CARDINAL-HF Steering Committee is further comprised of leading international heart failure clinical investigators. About PDE9 inhibition PDE9 inhibitors target phosphodiesterase (PDE) 9, an enzyme whose elevated activity in patients with heart failure reduces the beneficial effects of the natriuretic peptide (NP) pathway, fundamental to cardiovascular homeostasis. The beneficial effects of the NP signaling pathway in the heart muscle cell are mediated by cyclic guanosine monophosphate (cGMP) and activation of its downstream signaling molecule protein kinase G1. PDE9 is an enzyme that selectively degrades cGMP; therefore, by inhibiting PDE9, our goal is to preserve cGMP generation and enhance the beneficial natriuretic peptide signaling within heart muscle cells. About Chronic Heart Failure Heart failure is a prevalent and growing condition that is responsible for substantial morbidity and mortality. Approximately 6.5 million people in the United States suffer from heart failure, and 50 percent of these patients die from the condition within five years of diagnosis. One in five patients with heart failure are hospitalized annually, and 25% of these patients will be admitted again within a month of discharge. Approximately half of all patients with heart failure have reduced ejection fraction (HFrEF) and half have preserved ejection fraction (HFpEF). Despite the availability of drugs indicated to reduce morbidity and mortality in patients with both types of heart failure, substantial unmet medical need remains. About Cardurion Pharmaceuticals Cardurion Pharmaceuticals is a clinical-stage biotechnology company focused on the discovery and development of novel, next-generation therapeutics for the treatment of cardiovascular diseases. Cardurion was founded by physician-scientists with world-class expertise in cardiovascular signaling pathways, and a shared passion to find and develop a pipeline of novel treatment options to improve the lives of patients. Cardurion has two groundbreaking clinical programs in development, a PDE9 inhibitor targeting heart failure and the first ever CaMKII inhibitor in clinical development targeting multiple cardiovascular indications. Cardurion Pharmaceuticals has facilities in Burlington, Massachusetts and Shonan, Japan. For more information, please visit the company’s website at . View source version on businesswire.com: Contacts Kathryn Morris The Yates Network kathryn@theyatesnetwork.com Source: Cardurion Pharmaceuticals, Inc. View this news release online at:

An individual diagnosed with type 2 diabetes at age 30 years could see their life expectancy fall by as much as 14 years, an international team of researchers has warned. Even people who do not develop the condition until later in life – with a diagnosis at age 50 years – could see their life expectancy fall by up to six years, an analysis of data from 19 high-income countries found. An individual diagnosed with type 2 diabetes at age 30 years could see their life expectancy fall by as much as 14 years, an international team of researchers has warned. Even people who do not develop the condition until later in life -- with a diagnosis at age 50 years -- could see their life expectancy fall by up to six years, an analysis of data from 19 high-income countries found. The researchers say the findings, published in The Lancet Diabetes & Endocrinology, highlight the urgent need to develop and implement interventions that prevent or delay onset of diabetes, especially as the prevalence of diabetes among younger adults is rising globally. Increasing levels of obesity, poor diet and increased sedentary behaviour are driving a rapid rise in the number of cases of type 2 diabetes worldwide. In 2021, 537 million adults were estimated to have diabetes worldwide, with an increasing number diagnosed at younger ages. Type 2 diabetes increases an individual's risk of a range of complications including heart attack and stroke, kidney problems, and cancer. Previous estimates have suggested that adults with type 2 diabetes die, on average, six years earlier than adults without diabetes. There is uncertainty, however, about how this average reduction in life expectancy varies according to age at diagnosis. To answer this question, a team led by scientists at the University of Cambridge and University of Glasgow examined data from two major international studies -- the Emerging Risk Factors Collaboration and UK Biobank -- comprising a total of 1.5 million individuals. The earlier an individual was diagnosed with type 2 diabetes, the greater the reduction in their life expectancy. Overall, every decade of earlier diagnosis of diabetes was associated with about four years of reduced life expectancy. Using data from US population it was estimated that, individuals with type 2 diabetes diagnosed at ages 30, 40, and 50 years died on average about 14, 10, and 6 years earlier, respectively, than individuals without the condition. These estimates were slightly higher in women (16, 11, and 7 years, respectively) than they were in men (14, 9, and 5 years, respectively). The findings were broadly similar in analyses using EU data, with corresponding estimates being about 13, 9, or 5 years earlier death on average. Professor Emanuele Di Angelantonio from the Victor Phillip Dahdaleh Heart and Lung Research Institute (VPD-HLRI), University of Cambridge, said: "Type 2 diabetes used to be seen as a disease that affected older adults, but we're increasingly seeing people diagnosed earlier in life. As we've shown, this means they are at risk of a much shorter life expectancy than they would otherwise have." Dr Stephen Kaptoge, also from the VPD-HLRI, said: "Type 2 diabetes can be prevented if those at greatest risk can be identified and offered support -- whether that's to make changes to their behaviour or to provide medication to lower their risk. But there are also structural changes that we as a society should be pursuing, including relating to food manufacturing, changes to the built environment to encourage more physical activity, and so on. "Given the impact type 2 diabetes will have on people's lives, preventing -- or at least delaying the onset -- of the condition should be an urgent priority." The researchers found that the majority of the reduction in life expectancy associated with diabetes was due to 'vascular deaths' -- deaths related to conditions such as heart attack, stroke and aneurysms. Other complications such as cancer also contributed to lowering life expectancy. Professor Naveed Sattar from the Institute of Cardiovascular & Medical Sciences, University of Glasgow, added: "Our findings support the idea that the younger an individual is when they develop type 2 diabetes, the more damage their body accumulates from its impaired metabolism. But the findings also suggest that early detection of diabetes by screening followed by intensive glucose management could help prevent long-term complications from the condition." The Cambridge team was supported by the Medical Research Council, British Heart Foundation, Health Data Research UK and NIHR Cambridge Biomedical Research Centre.

SOUTH SAN FRANCISCO, Calif., June 30, 2021 (GLOBE NEWSWIRE) -- Cytokinetics, Incorporated (Nasdaq: CYTK) today announced that additional results from GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) were presented at Heart Failure 2021, an International Congress of the European Society of Cardiology, including a prespecified subgroup analysis of the influence of atrial fibrillation or flutter (AFF) on the treatment effect of omecamtiv mecarbil in a Late Breaking Clinical Trial Session. Other analyses were presented in the Clinical Trial Updates Session related to which patients in GALACTIC-HF achieved an increased treatment effect with omecamtiv mecarbil. “These new analyses add to other data from GALACTIC-HF underscoring that patients with markers of more severe heart failure derived greater treatment benefit from omecamtiv mecarbil,” said Fady I. Malik, M.D., Ph.D., Cytokinetics’ Executive Vice President of Research & Development. “Many patients with severe heart failure still remain at risk, despite available guideline-directed therapy. Omecamtiv mecarbil may offer a new treatment option for these more severe heart failure patients who are also in greatest need.” GALACTIC-HF: Patients Without Atrial Fibrillation or Flutter Have Increased Treatment Effect with Omecamtiv Mecarbil Scott Solomon, M.D., the Edward D. Frohlich Distinguished Chair, Professor of Medicine, Harvard Medical School and Director of Noninvasive Cardiology, Brigham and Women's Hospital, presented additional analyses from GALACTIC-HF assessing how baseline AFF in patients impacted the effectiveness of omecamtiv mecarbil in GALACTIC-HF. Of the 8,256 patients enrolled in GALACTIC-HF, 2,245 patients (27%) had AFF at baseline; these patients were older, more likely to be randomized as inpatients, had a higher New York Heart Association (NYHA) class and had higher NT-proBNP compared to patients without AFF. The effect of treatment with omecamtiv mecarbil on the primary composite endpoint of heart failure events (heart failure hospitalization and other urgent treatment for heart failure) or cardiovascular (CV) death was greater in patients without baseline AFF compared to those patients with AFF at baseline (interaction p=0.012). Importantly, the modification of the treatment effect by AFF was concentrated in patients with AFF using digoxin (n=692) with minimal evidence of effect modification in patients with AFF not using digoxin (n=1553). Digoxin did not modify the treatment effect of omecamtiv mecarbil in patients without AFF. These findings suggest caution should be exercised when treating patients with AFF using both digoxin and omecamtiv mecarbil. Interestingly, given prior observations of the positive impact of omecamtiv mecarbil on left atrial function, an exploratory analysis from GALACTIC-HF indicated fewer serious adverse events of atrial fibrillation in patients without AFF at baseline in patients treated with omecamtiv mecarbil compared to placebo (55 events in 2,974 patients treated with omecamtiv mecarbil vs. 78 events in 3,013 patients treated with placebo, p=0.046). GALACTIC-HF: Patients with Higher Baseline NT-proBNP Have Increased Treatment Effect with Omecamtiv Mecarbil In a separate analysis, John McMurray, M.D., Professor of Medical Cardiology & Honorary Consultant Cardiologist, Institute of Cardiovascular & Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, presented analyses on the effect of treatment with omecamtiv mecarbil according to baseline NT-proBNP in patients without AFF, as well as in all patients in GALACTIC-HF. NT-proBNP is a biomarker of ventricular wall stress in which higher levels reflect more severe heart failure. Among the 5,971 patients who did not have AFF, the median (Q1, Q3) NT-proBNP level was 1,675 (812-3579 pg/ml). In patients without AFF, the treatment effect of omecamtiv mecarbil on the primary composite endpoint was increased in patients with a baseline NT-proBNP above the median (hazard ratio, 0.81; 95% confidence interval 0.73-0.90) compared to patients with baseline NT-proBNP equal to or below the median (HR, 0.94; 95% CI 0.80-1.09; interaction p=0.095). The same pattern was observed in the overall population in which patients with a baseline NT-proBNP greater than the median experienced an increased treatment effect (HR, 0.88; 95% CI 0.80-0.96) compared to patients with a baseline NT-proBNP equal to or below the median (HR, 1.01; 95% CI 0.90-1.15; interaction p=0.035.) Examined as a continuous variable, there was an interaction between treatment with omecamtiv mecarbil and baseline NT-proBNP that showed an increased treatment effect on the primary outcome in patients as baseline NT-proBNP increased both in those without AFF (interaction p=0.024) and in the overall population (interaction p=0.005). These findings suggest the benefit of treatment with omecamtiv mecarbil increased progressively as baseline NT-proBNP increased consistent with other analyses from GALACTIC-HF that suggest more severe heart failure patients may derive increased benefit from treatment with omecamtiv mecarbil. GALACTIC-HF: Patients with Severe Heart Failure Have Increased Treatment Effect with Omecamtiv Mecarbil Michael Felker, M.D., Professor of Medicine, Duke Clinical Research Institute presented an analysis of the treatment effect of omecamtiv mecarbil on the primary composite endpoint in patients from GALACTIC-HF classified as having severe heart failure based on modified criteria from the Heart Failure Association of the European Society of Cardiology (ESC-HFA) advanced heart failure position statement. Patients in this subgroup had NYHA class III-IV symptoms, EF ≤ 30%, and hospitalization for heart failure within the prior six months. Of patients enrolled in GALACTIC-HF, 2,258 (27%) met these criteria for severe heart failure. Patients with severe heart failure had markers of more advanced disease and higher baseline risk, with event rates in patients treated with placebo that were approximately twice those of patients without severe heart failure. In patients with severe heart failure, the treatment effect of omecamtiv mecarbil on the primary composite endpoint was increased (HR, 0.80; 95% CI 0.71-0.90) compared to patients without severe heart failure (HR, 0.99; 95% CI 0.91-1.08; interaction p=0.005). The results for CV death were qualitatively similar; patients with severe heart failure experienced a trend towards treatment benefit from omecamtiv mecarbil (HR, 0.88; 95% CI 0.75-1.03) while patients without severe heart failure did not (HR, 1.10, 95% CI 0.97-1.25; interaction p=0.028). Furthermore, as the severity of heart failure increased, as indicated by the number of the three severity criteria met, both the incidence of the primary composite endpoint and the treatment effect of omecamtiv mecarbil increased. Omecamtiv mecarbil was equally well tolerated in patients with and without severe heart failure, with no significant changes in blood pressure, renal function, or potassium compared to placebo. These results from GALACTIC-HF demonstrate a potentially clinically important treatment effect of omecamtiv mecarbil in patients with severe heart failure. About Omecamtiv Mecarbil and the Phase 3 Clinical Trials Program Omecamtiv mecarbil is an investigational selective cardiac myosin activator, the first of a novel class of myotropes1 designed to directly target the contractile mechanisms of the heart, binding to and recruiting more cardiac myosin heads to interact with actin during systole. Preclinical research has shown that omecamtiv mecarbil increases cardiac contractility without increasing intracellular myocyte calcium concentrations or myocardial oxygen consumption.2-4 Cardiac myosin is the cytoskeletal motor protein in the cardiac muscle cell that is directly responsible for converting chemical energy into the mechanical force resulting in cardiac contraction. Omecamtiv mecarbil is being developed for the potential treatment of HFrEF and is the subject of a comprehensive Phase 3 clinical trials program composed of GALACTIC-HF and METEORIC-HF. The results from GALACTIC-HF, published in the New England Journal of Medicine, demonstrated a statistically significant effect of treatment with omecamtiv mecarbil to reduce risk of the primary composite endpoint of time to first heart failure event (heart failure hospitalization and other urgent treatment for heart failure) or cardiovascular (CV) death compared to placebo in patients treated with standard of care (hazard ratio, 0.92; 95% confidence interval [CI] 0.86, 0.99; p=0.025). No reduction in the secondary endpoint of time to CV death was observed in the overall population.5 Supplemental analyses indicated a greater treatment effect in patients with a lower LVEF (LVEF ≤28%, n=4,456, hazard ratio, 0.84; 95% CI 0.77, 0.92; interaction p=0.003). Effects in GALACTIC-HF were observed without evidence of an increase in the overall rates of myocardial ischemic events, ventricular arrhythmias or death from cardiovascular or all causes. About Heart Failure Heart failure is a grievous condition that affects more than 64 million people worldwide6 about half of whom have reduced left ventricular function.7,8 It is the leading cause of hospitalization and readmission in people age 65 and older.9,10 Despite broad use of standard treatments and advances in care, the prognosis for patients with heart failure is poor.11 An estimated one in five people over the age of 40 are at risk of developing heart failure, and approximately 50 percent of people diagnosed with heart failure are expected to die within five years of initial hospitalization.12,13 More than 2 million people in the U.S. are estimated to have an ejection fraction <30%, indicating they may have severe heart failure.14 About Cytokinetics Cytokinetics is a late-stage biopharmaceutical company focused on discovering, developing and commercializing first-in-class muscle activators and next-in-class muscle inhibitors as potential treatments for debilitating diseases in which muscle performance is compromised and/or declining. As a leader in muscle biology and the mechanics of muscle performance, the company is developing small molecule drug candidates specifically engineered to impact muscle function and contractility. Cytokinetics is preparing a U.S. NDA submission of omecamtiv mecarbil, its novel cardiac muscle activator, based on positive results from GALACTIC-HF, a large, international Phase 3 clinical trial in patients with heart failure. Cytokinetics is also conducting METEORIC-HF, a second Phase 3 clinical trial of omecamtiv mecarbil. Cytokinetics is also developing CK-274, a next-generation cardiac myosin inhibitor, for the potential treatment of hypertrophic cardiomyopathies (HCM). Cytokinetics is conducting REDWOOD-HCM, a Phase 2 clinical trial of CK-274 in patients with obstructive HCM. Cytokinetics is also developing reldesemtiv, a fast skeletal muscle troponin activator for the potential treatment of ALS and other neuromuscular indications following conduct of FORTITUDE-ALS and other Phase 2 clinical trials. The company is preparing for the potential advancement of CK-274 to a Phase 3 clinical trial in obstructive HCM and reldesemtiv to a Phase 3 clinical trial in ALS. Cytokinetics continues its over 20-year history of pioneering innovation in muscle biology and related pharmacology focused to diseases of muscle dysfunction and conditions of muscle weakness. For additional information about Cytokinetics, visit  and follow us on Twitter, LinkedIn, Facebook and YouTube. Forward-Looking Statements This press release contains forward-looking statements for purposes of the Private Securities Litigation Reform Act of 1995 (the "Act"). Cytokinetics disclaims any intent or obligation to update these forward-looking statements and claims the protection of the Act's Safe Harbor for forward-looking statements. Examples of such statements include, but are not limited to, the potential benefits of omecamtiv mecarbil, including its ability to represent a novel therapeutic strategy to increase cardiac muscle function and restore cardiac performance; the timing and likelihood of any regulatory submissions or approval of omecamtiv mecarbil, the potential number of patients that could benefit from treatment with omecamtiv mecarbil, the potential advancement of reldesemtiv to a phase 3 clinical trial in ALS, Cytokinetics' other research and development activities; the design, timing, results, significance and utility of preclinical and clinical results; and the properties and potential benefits of Cytokinetics' other drug candidates. Such statements are based on management's current expectations, but actual results may differ materially due to various risks and uncertainties, including, but not limited to, potential difficulties or delays in the development, testing, regulatory approvals for trial commencement, progression or product sale or manufacturing, or production of Cytokinetics' drug candidates that could slow or prevent clinical development or product approval; Cytokinetics' drug candidates may have adverse side effects or inadequate therapeutic efficacy; the FDA or foreign regulatory agencies may delay or limit Cytokinetics' ability to conduct clinical trials; Cytokinetics may be unable to obtain or maintain patent or trade secret protection for its intellectual property; standards of care may change, rendering Cytokinetics' drug candidates obsolete; and competitive products or alternative therapies may be developed by others for the treatment of indications Cytokinetics' drug candidates and potential drug candidates may target. For further information regarding these and other risks related to Cytokinetics' business, investors should consult Cytokinetics' filings with the Securities and Exchange Commission. Contact:CytokineticsDiane WeiserSenior Vice President, Corporate Communications, Investor Relations(415) 290-7757 References