This drug entry is a stub and has not been fully annotated. It is scheduled to be annotated soon.

Identification

Summary

Mavacamten is a myosin inhibitor used to treat obstructive hypertrophic cardiomyopathy.

Brand Names
Camzyos
Generic Name
Mavacamten
DrugBank Accession Number
DB14921
Background

Mavacamten is a myosin inhibitor indicated for the treatment of adults with symptomatic New York Heart Association (NYHA) class II-III obstructive hypertrophic cardiomyopathy (HCM). It received initial US FDA approval in 2022, and it is one of the first myosin inhibitors to be used in humans.12

Type
Small Molecule
Groups
Approved, Investigational
Structure
Weight
Average: 273.336
Monoisotopic: 273.147726864
Chemical Formula
C15H19N3O2
Synonyms
  • Mavacamten

Pharmacology

Indication

Mavacamten is indicated for the treatment of adults with symptomatic New York Heart Association (NYHA) class II-III obstructive hypertrophic cardiomyopathy (HCM) to improve functional capacity and symptoms.13

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Associated Conditions
Contraindications & Blackbox Warnings
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Pharmacodynamics

Mavacamten is a myosin inhibitor to prevent muscle hypercontractility. It binds to myosin and inhibits myosin interaction with actin at various stages of the thermomechanical cycle. Mechanistic studies show that mavacamten can inhibit myosin in both its active and relaxed form, thus effectively alleviating excess sarcomere power, a hallmark of hypertrophic cardiomyopathy.13,12

In the EXPLORER-HCM trial, patients achieved reductions in mean resting and provoked (Valsalva) LVOT gradient by Week 4 which were sustained throughout the 30-week trial. At Week 30, the mean (SD) changes from baseline in resting and Valsalva LVOT gradients were -39 (29) mmHg and -49 (34) mmHg, respectively, for the CAMZYOS group and -6 (28) mmHg and -12 (31) mmHg, respectively, for the placebo group. The reductions in the Valsalva LVOT gradient were accompanied by decreases in LVEF, generally within the normal range. Eight weeks after discontinuation of CAMZYOS, mean LVEF and Valsalva LVOT gradients were similar to baseline.13

Echocardiographic measurements of the cardiac structure showed a mean (SD) reduction from baseline at Week 30 in left ventricular mass index (LVMI) in the mavacamten group (-7.4 [17.8] g/m2) versus an increase in LVMI in the placebo group (8.9 [15.3] g/m2). There was also a mean (SD) reduction from baseline in left atrial volume index (LAVI) in the mavacamten group(-7.5 [7.8] mL/m2) versus no change in the placebo group (-0.1 [8.7] mL/m2). The clinical significance of these findings is unknown.13

A reduction in a biomarker of cardiac wall stress, NT-proBNP, was observed by Week 4 and sustained through the end of treatment. At Week 30 compared with baseline, the reduction in NT-proBNP after mavacamten treatment was 80% greater than for placebo (proportion of geometric mean ratio between the two groups, 0.20 [95% CI: 0.17, 0.24]). The clinical significance of these findings is unknown.13

In healthy volunteers receiving multiple doses of mavacamten, a concentration-dependent increase in the QTc interval was observed at doses up to 25 mg once daily. No acute QTc changes have been observed at similar exposures during single-dose studies. The mechanism of the QT prolongation effect is not known. A meta-analysis across clinical studies in HCM patients does not suggest clinically relevant increases in the QTc interval in the therapeutic exposure range. In HCM, the QT interval may be intrinsically prolonged due to the underlying disease, in association with ventricular pacing, or in association with drugs with the potential for QT prolongation commonly used in the HCM population. The effect of coadministration of mavacamten with QT-prolonging drugs or in patients with potassium channel variants resulting in a long QT interval has not been characterized.13

Mechanism of action

Myosin is a family of enzymes that can produce mechanical output by an ATP-mediated cyclic interaction with actin. When ATP is bound to the myosin head, it is hydrolyzed into ADP and organophosphate by myosin ATPase activity, and the energy produced from the reaction is stored in the myosin head. As the organophosphate dissociates from myosin, it shifts myosin into a strong binding state to actin, thus creating a myosin-actin complex otherwise known as "cross-bridging".2,3,5Dissociation of the organophosphate also causes a conformation change in myosin that creates strain in the actin-myosin bridge that can only be released once the actin and myosin filaments slide past each other, thus shortening the sarcomere and create a muscle contraction.5,9 Once the sliding is completed, ADP is released to create further movement of the myosin head.9 Although this ADP release-induced movement is minor and unlikely to contribute to the sarcomere movement, researchers have hypothesized that this movement is likely essential in limiting the sliding velocity of actin.6,7,8,9Finally, myosin then bind to a new ATP molecule to initiate the chemomechanical cycle again.

Mavacamten reduces sarcomere hypercontractility by acting as an allosteric and reversible modulator of the beta-cardiac isoform of myosin to reduce its ATPase activity, thus reducing actin-myosin cross bridging.4 Specifically, mavacamten inhibits the phosphate release, the cycle's rate-limiting step, without affecting the ADP release rate in actin-bound myosin.1Also, mavacamten inhibits binding of ADP-bound myosin to actin as well as ADP release to prime the myosin head to initiate turnover.3Recently, it was also discovered when myosin is not in its active state to interact with actin, it exists in equilibrium between 2 energy sparing states: a disordered relaxed state, where interaction between actin and myosin by the thin filament regulatory proteins, and a super relaxed state, where significant myosin head-to-head interaction lengthen ATP turnover rate.10,11. Mavacamten's binding to myosin can shift the equilibrium toward the super relaxed state, effectively exerting both a basal and actin-activated ATP inhibition.10,13

TargetActionsOrganism
AMyosin-7
inhibitory allosteric modulator
Humans
Absorption

Mavacamten has an estimated oral bioavailability of at least 85% and Tmax of 1 hour.13 Mavacamten exposures (AUC) increased up to 220% in patients with mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment. The effect of severe (Child-Pugh C) hepatic impairment is unknown.13

Volume of distribution

Through the use of a simple 4-species (mouse, rat, dog, and cynomolgus monkey) allometric scaling of unbound blood steady-state volume of distribution, the human volume of distribution of mavacamten is predicted to be 9.5 L/kg.1

Protein binding

Plasma protein binding of mavacamten is between 97 and 98%.13

Metabolism

Mavacamten is extensively metabolized, primarily through CYP2C19 (74%), CYP3A4 (18%), and CYP2C9 (8%).13

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Route of elimination

Following a single 25 mg dose of radiolabeled mavacamten, 7% of the dose was recovered in feces (1% unchanged) and 85% in urine (3% unchanged).13

Half-life

Mavacamten has a variable terminal t1/2 that depends on CYP2C19 metabolic status. Mavacamten's terminal half-life is 6-9 days in CYP2C19 normal metabolizers (NMs), which is prolonged in CYP2C19 poor metabolizers (PMs) to 23 days.13

Clearance

Mavacamten demonstrates a long terminal half-life and thus low clearance, with an estimated plasma clearance using human hepatocytes of less than 4.9 mL/min/kg.1 Assuming a one-compartment model, using simple allometric scaling of unbound blood clearance of mouse, rat, dog, and cynomolgus monkey, human plasma clearance of mavacamten is estimated to be 0.51 mL/min/kg.1

Adverse Effects
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Toxicity

Human experience of overdose with CAMZYOS is limited. CAMZYOS has been given as a single dose of up to 144 mg in patients with HCM. One subject administered a single dose of 144 mg experienced serious adverse events including vasovagal reaction, hypotension, and asystole, but the subject recovered. In healthy subjects, doses of up to 25 mg have been administered for up to 25 days, with 3 of 8 participants treated at the 25-mg dose level experiencing 20% or greater reductions in LVEF. An infant's death was reported after accidental ingestion of three 15-mg capsules.13

Systolic dysfunction is the most likely result of overdosage of CAMZYOS. Treatment of overdose with CAMZYOS consists of discontinuation of CAMZYOS treatment as well as medically supportive measures to maintain hemodynamic stability, including close monitoring of vital signs and LVEF and management of the clinical status of the patient. Overdose in humans can be life-threatening and result in asystole refractory to any medical intervention.13

Mavacamten was not genotoxic in a bacterial reverse mutation test (Ames test), a human in vitro lymphocyte clastogenicity assay, or a rat in vivo micronucleus assay. There was no evidence of carcinogenicity seen in a 6-month rasH2 transgenic mouse study at mavacamten doses of up to 2.0 mg/kg/day in males and 3.0 mg/kg/day in females, which resulted in exposures (AUC) that were 1.8- and 3-fold in males and females, respectively, compared to AUC exposures in humans at the MRHD.13

In reproductive toxicity studies, there was no evidence of the effects of mavacamten on mating and fertility in male or female rats at doses up to 1.2 mg/kg/day, or on the viability and fertility of offspring of dams dosed up to 1.5 mg/kg/day. Plasma exposure (AUC) of mavacamten at the highest dose tested was the same as in humans at the MRHD.13

The safety of mavacamten has been evaluated in rats and dogs at multiple dose levels (0.06 to 10 mg/kg/day) orally. Noted toxicities, including echocardiographic findings, reduction in systolic function, cardiac dilation, and death, as well as increased heart weights in rats, were consistent with mavacamten’s mechanism of action and primary pharmacological activity. Other findings included cardiac osseous metaplasia in rats and QTc prolongation in dogs. Plasma exposures (AUC) at the NOAEL in rats and dogs were 0.1 and 0.3 times, respectively, human exposure (AUC) at the MRHD.13

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
1,2-BenzodiazepineThe serum concentration of 1,2-Benzodiazepine can be decreased when it is combined with Mavacamten.
AbametapirThe serum concentration of Mavacamten can be increased when it is combined with Abametapir.
AbataceptThe metabolism of Mavacamten can be increased when combined with Abatacept.
AbemaciclibThe serum concentration of Abemaciclib can be decreased when it is combined with Mavacamten.
AbirateroneThe serum concentration of Abiraterone can be decreased when it is combined with Mavacamten.
AbrocitinibThe serum concentration of Abrocitinib can be decreased when it is combined with Mavacamten.
AcalabrutinibThe serum concentration of Acalabrutinib can be decreased when it is combined with Mavacamten.
AcenocoumarolThe serum concentration of Acenocoumarol can be decreased when it is combined with Mavacamten.
AcetaminophenThe serum concentration of Acetaminophen can be decreased when it is combined with Mavacamten.
AcetohexamideThe serum concentration of Acetohexamide can be decreased when it is combined with Mavacamten.
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Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
CamzyosCapsule, gelatin coated15 mg/1OralMyokardia, Inc.2022-04-28Not applicableUS flag
CamzyosCapsule, gelatin coated2.5 mg/1OralMyokardia, Inc.2022-04-28Not applicableUS flag
CamzyosCapsule, gelatin coated10 mg/1OralMyokardia, Inc.2022-04-28Not applicableUS flag
CamzyosCapsule, gelatin coated5 mg/1OralMyokardia, Inc.2022-04-28Not applicableUS flag

Categories

Drug Categories
Classification
Not classified
Affected organisms
Not Available

Chemical Identifiers

UNII
QX45B99R3J
CAS number
1642288-47-8
InChI Key
RLCLASQCAPXVLM-NSHDSACASA-N
InChI
InChI=1S/C15H19N3O2/c1-10(2)18-14(19)9-13(17-15(18)20)16-11(3)12-7-5-4-6-8-12/h4-11,16H,1-3H3,(H,17,20)/t11-/m0/s1
IUPAC Name
6-{[(1S)-1-phenylethyl]amino}-3-(propan-2-yl)-1,2,3,4-tetrahydropyrimidine-2,4-dione
SMILES
CC(C)N1C(=O)NC(N[C@@H](C)C2=CC=CC=C2)=CC1=O

References

General References
  1. Grillo MP, Erve JCL, Dick R, Driscoll JP, Haste N, Markova S, Brun P, Carlson TJ, Evanchik M: In vitro and in vivo pharmacokinetic characterization of mavacamten, a first-in-class small molecule allosteric modulator of beta cardiac myosin. Xenobiotica. 2019 Jun;49(6):718-733. doi: 10.1080/00498254.2018.1495856. Epub 2018 Oct 1. [Article]
  2. Pham S, Puckett Y: Physiology, Skeletal Muscle Contraction . [Article]
  3. Kawas RF, Anderson RL, Ingle SRB, Song Y, Sran AS, Rodriguez HM: A small-molecule modulator of cardiac myosin acts on multiple stages of the myosin chemomechanical cycle. J Biol Chem. 2017 Oct 6;292(40):16571-16577. doi: 10.1074/jbc.M117.776815. Epub 2017 Aug 14. [Article]
  4. Green EM, Wakimoto H, Anderson RL, Evanchik MJ, Gorham JM, Harrison BC, Henze M, Kawas R, Oslob JD, Rodriguez HM, Song Y, Wan W, Leinwand LA, Spudich JA, McDowell RS, Seidman JG, Seidman CE: A small-molecule inhibitor of sarcomere contractility suppresses hypertrophic cardiomyopathy in mice. Science. 2016 Feb 5;351(6273):617-21. doi: 10.1126/science.aad3456. [Article]
  5. Brenner B, Eisenberg E: The mechanism of muscle contraction. Biochemical, mechanical, and structural approaches to elucidate cross-bridge action in muscle. Basic Res Cardiol. 1987;82 Suppl 2:3-16. doi: 10.1007/978-3-662-11289-2_1. [Article]
  6. Jackson DR Jr, Baker JE: The energetics of allosteric regulation of ADP release from myosin heads. Phys Chem Chem Phys. 2009 Jun 28;11(24):4808-14. doi: 10.1039/b900998a. Epub 2009 May 8. [Article]
  7. Siemankowski RF, Wiseman MO, White HD: ADP dissociation from actomyosin subfragment 1 is sufficiently slow to limit the unloaded shortening velocity in vertebrate muscle. Proc Natl Acad Sci U S A. 1985 Feb;82(3):658-62. doi: 10.1073/pnas.82.3.658. [Article]
  8. Veigel C, Wang F, Bartoo ML, Sellers JR, Molloy JE: The gated gait of the processive molecular motor, myosin V. Nat Cell Biol. 2002 Jan;4(1):59-65. doi: 10.1038/ncb732. [Article]
  9. Houdusse A, Sweeney HL: How Myosin Generates Force on Actin Filaments. Trends Biochem Sci. 2016 Dec;41(12):989-997. doi: 10.1016/j.tibs.2016.09.006. Epub 2016 Oct 4. [Article]
  10. Gollapudi SK, Ma W, Chakravarthy S, Combs AC, Sa N, Langer S, Irving TC, Nag S: Two Classes of Myosin Inhibitors, Para-nitroblebbistatin and Mavacamten, Stabilize beta-Cardiac Myosin in Different Structural and Functional States. J Mol Biol. 2021 Nov 19;433(23):167295. doi: 10.1016/j.jmb.2021.167295. Epub 2021 Oct 8. [Article]
  11. McNamara JW, Li A, Dos Remedios CG, Cooke R: The role of super-relaxed myosin in skeletal and cardiac muscle. Biophys Rev. 2015 Mar;7(1):5-14. doi: 10.1007/s12551-014-0151-5. Epub 2014 Dec 20. [Article]
  12. Pysz P, Rajtar-Salwa R, Smolka G, Olivotto I, Wojakowski W, Petkow-Dimitrow P: Mavacamten - a new disease-specific option for pharmacological treatment of symptomatic patients with hypertrophic cardiomyopathy. Kardiol Pol. 2021;79(9):949-954. doi: 10.33963/KP.a2021.0064. Epub 2021 Jul 16. [Article]
  13. FDA Approved Drug Proucts: CAMZYOS (mavacamten) capsules for oral use [Link]
ChemSpider
57876199
RxNav
2600867
ChEMBL
CHEMBL4297517
Wikipedia
Mavacamten

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
3CompletedTreatmentObstructive Hypertrophic Cardiomyopathy1
3Not Yet RecruitingTreatmentObstructive Hypertrophic Cardiomyopathy1
3RecruitingTreatmentObstructive Hypertrophic Cardiomyopathy2
2Active Not RecruitingTreatmentHypertrophic Cardiomyopathy (HCM)1
2CompletedTreatmentNon-obstructive Hypertrophic Cardiomyopathy1
2RecruitingTreatmentHeart Failure With Preserved Ejection Fraction (HFpEF)1
2, 3Enrolling by InvitationTreatmentHypertrophic Cardiomyopathy (HCM) / Non-obstructive Hypertrophic Cardiomyopathy / Obstructive Hypertrophic Cardiomyopathy1
1CompletedTreatmentHypertrophic Cardiomyopathy (HCM)1
1Not Yet RecruitingTreatmentHealthy Subjects (HS)1
1RecruitingTreatmentHealthy Subjects (HS)1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Capsule, gelatin coatedOral10 mg/1
Capsule, gelatin coatedOral15 mg/1
Capsule, gelatin coatedOral2.5 mg/1
Capsule, gelatin coatedOral5 mg/1
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.226 mg/mLALOGPS
logP2.1ALOGPS
logP2.21ChemAxon
logS-3.1ALOGPS
pKa (Strongest Acidic)10.7ChemAxon
pKa (Strongest Basic)-3.3ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count3ChemAxon
Hydrogen Donor Count2ChemAxon
Polar Surface Area61.44 Å2ChemAxon
Rotatable Bond Count4ChemAxon
Refractivity86.78 m3·mol-1ChemAxon
Polarizability29.92 Å3ChemAxon
Number of Rings2ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available

Targets

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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitory allosteric modulator
General Function
Microfilament motor activity
Specific Function
Muscle contraction.
Gene Name
MYH7
Uniprot ID
P12883
Uniprot Name
Myosin-7
Molecular Weight
223095.5 Da
References
  1. Kawas RF, Anderson RL, Ingle SRB, Song Y, Sran AS, Rodriguez HM: A small-molecule modulator of cardiac myosin acts on multiple stages of the myosin chemomechanical cycle. J Biol Chem. 2017 Oct 6;292(40):16571-16577. doi: 10.1074/jbc.M117.776815. Epub 2017 Aug 14. [Article]

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP2C8
Uniprot ID
P10632
Uniprot Name
Cytochrome P450 2C8
Molecular Weight
55824.275 Da
References
  1. Grillo MP, Erve JCL, Dick R, Driscoll JP, Haste N, Markova S, Brun P, Carlson TJ, Evanchik M: In vitro and in vivo pharmacokinetic characterization of mavacamten, a first-in-class small molecule allosteric modulator of beta cardiac myosin. Xenobiotica. 2019 Jun;49(6):718-733. doi: 10.1080/00498254.2018.1495856. Epub 2018 Oct 1. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Oxygen binding
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP3A5
Uniprot ID
P20815
Uniprot Name
Cytochrome P450 3A5
Molecular Weight
57108.065 Da
References
  1. Grillo MP, Erve JCL, Dick R, Driscoll JP, Haste N, Markova S, Brun P, Carlson TJ, Evanchik M: In vitro and in vivo pharmacokinetic characterization of mavacamten, a first-in-class small molecule allosteric modulator of beta cardiac myosin. Xenobiotica. 2019 Jun;49(6):718-733. doi: 10.1080/00498254.2018.1495856. Epub 2018 Oct 1. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
Inducer
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP2C9
Uniprot ID
P11712
Uniprot Name
Cytochrome P450 2C9
Molecular Weight
55627.365 Da
References
  1. FDA Approved Drug Proucts: CAMZYOS (mavacamten) capsules for oral use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
Inducer
General Function
Steroid hydroxylase activity
Specific Function
Responsible for the metabolism of a number of therapeutic agents such as the anticonvulsant drug S-mephenytoin, omeprazole, proguanil, certain barbiturates, diazepam, propranolol, citalopram and im...
Gene Name
CYP2C19
Uniprot ID
P33261
Uniprot Name
Cytochrome P450 2C19
Molecular Weight
55930.545 Da
References
  1. FDA Approved Drug Proucts: CAMZYOS (mavacamten) capsules for oral use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
Inducer
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. FDA Approved Drug Proucts: CAMZYOS (mavacamten) capsules for oral use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Inducer
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP2B6
Uniprot ID
P20813
Uniprot Name
Cytochrome P450 2B6
Molecular Weight
56277.81 Da
References
  1. FDA Approved Drug Proucts: CAMZYOS (mavacamten) capsules for oral use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
General Function
Steroid hydroxylase activity
Specific Function
Responsible for the metabolism of many drugs and environmental chemicals that it oxidizes. It is involved in the metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic...
Gene Name
CYP2D6
Uniprot ID
P10635
Uniprot Name
Cytochrome P450 2D6
Molecular Weight
55768.94 Da
References
  1. Grillo MP, Erve JCL, Dick R, Driscoll JP, Haste N, Markova S, Brun P, Carlson TJ, Evanchik M: In vitro and in vivo pharmacokinetic characterization of mavacamten, a first-in-class small molecule allosteric modulator of beta cardiac myosin. Xenobiotica. 2019 Jun;49(6):718-733. doi: 10.1080/00498254.2018.1495856. Epub 2018 Oct 1. [Article]

Drug created at May 20, 2019 14:35 / Updated at May 29, 2022 14:07