Bristol Myers Squibb to Present Data Across Robust Cardiovascular Portfolio at American Heart Association Scientific Sessions 2021
Bristol Myers Squibb (NYSE: BMY) presented comprehensive research on its cardiovascular portfolio at the American Heart Association's annual Scientific Sessions from November 13-15, 2021. Key presentations included results from the AXIOMATIC-TKR study, exploring milvexian's efficacy in total knee replacement surgery, and analyses on mavacamten for obstructive hypertrophic cardiomyopathy. Researchers emphasized commitment to advancing treatment options for cardiovascular disease, a leading global health issue.
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“At Bristol Myers Squibb, we have pioneered the science behind many classes of transformational treatments, and are committed to continued progress in cardiovascular disease, as it remains a leading cause of death globally,” said
Key presentations include:
- A late breaking presentation, sponsored by The Bristol Myers Squibb-Janssen Collaboration, on the results from the Phase 2 proof-of-concept AXIOMATIC-TKR study evaluating the efficacy and safety of milvexian, an oral Factor XIa inhibitor, compared to subcutaneous enoxaparin at a broad range of doses in patients undergoing elective total knee replacement (TKR) surgery.
- A poster presentation of subgroup analyses from the Phase 3 studies EXPLORER-HCM and MAVA-LTE evaluating mavacamten’s efficacy and tolerability in patients with obstructive hypertrophic cardiomyopathy (obstructive HCM) added to a Beta-blocker background. Data demonstrates mavacamten benefit for symptomatic obstructive HCM patients with or without Beta-blocker therapy.
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A poster presentation, sponsored by
The Bristol Myers Squibb-Pfizer Alliance , reporting results from a Phase 1 study evaluating Eliquis® (apixaban) in pediatric subjects at risk for venous or arterial thrombotic disorder.
Summary of Select Presentations
Abstract Title |
Primary
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Type/# |
Session Title |
Time |
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Long-Term Efficacy and Safety of Mavacamten in Patients with Non-Obstructive Hypertrophic Cardiomyopathy: Interim Results from the MAVERICK-LTE Cohort of the MAVA-LTE Study |
Owens, A |
Poster -
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HF.RFO.31 - Prognostic Indicators and Management of Hf |
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Efficacy of Mavacamten in Patients with Symptomatic Hypertrophic Cardiomyopathy: Sub-group Analyses By Background Beta-blocker Use From The EXPLORER-HCM and MAVA-LTE Studies |
Jacoby, D |
Poster –
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HF.APS.32 - What’s Hot in Hypertrophic Cardiomyopathy, Cardiac Amyloid, and Pericarditis |
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Estimated Number Needed to Treat with Mavacamten Vs Placebo to Improve Functional Capacity and Left Ventricular Outflow Tract Obstruction in Patients with Symptomatic Obstructive Hypertrophic Cardiomyopathy |
Semigran, M |
Poster –
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HF.APS.1203 - Heart Failure – Cardiomyopathy and Device Therapy |
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Antithrombotic Strategies According to Age in Patients with Atrial Fibrillation and a Recent Acute Coronary Syndrome or Percutaneous Coronary Intervention: Insights from the AUGUSTUS Trial (Sponsored by |
Guimaraes, P
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Poster –
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EA.MDP.72 - Optimizing Atrial Fibrillation Management: Risk Factor Modification and Medical Therapy |
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Phase 1 Single-Dose Study to Evaluate Apixaban in Pediatric Subjects at Risk for Venous or Arterial Thrombotic Disorder (Sponsored by |
Garonzik, S
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Poster –
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VA.APS.01 - Abstracts from the Vascular Wall of Fame, Part I |
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Contemporary Evidence on Risk Stratification of Anticoagulated Non-Valvular Atrial Fibrillation Patients Grouped by CHA2D2-vasc Score Levels (Sponsored by |
Lip, GYH |
Poster –
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EP.APS.12 - Novel Insights in Atrial Fibrillation and Arrhythmias
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Rates and Predictors of Treatment with Oral Anticoagulant in Patients Newly Diagnosed with Atrial Fibrillation at High-Risk for Stroke (Sponsored by |
Manning, E |
Poster –
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EP.APS.13 - Exercise, Diet and Lifestyle Influences on CVD |
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Milvexian for Prevention of Venous Thromboembolism After Elective Knee Arthroplasty: The AXIOMATIC-TKR Study (Sponsored by The Bristol Myers Squibb-Janssen Collaboration) |
Weitz, J I |
LBS.07 - New Drugs and New Drug Indications in Cardiovascular Disease |
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About Milvexian
Milvexian is a potential first-in-class oral Factor XIa (FXIa) inhibitor (anti-thrombotic) for the prevention and treatment of major thrombotic conditions. The milvexian Phase 2 clinical trial program consists of two Phase 2 studies: AXIOMATIC-TKR (NCT03891524) evaluating milvexian in TKR surgery and AXIOMATIC-SSP (NCT03766581) evaluating milvexian in secondary stroke prevention (SSP).
Milvexian is an investigational agent and has not been approved for use in any country, for any indication. Milvexian is being developed by The Bristol Myers Squibb-Janssen Collaboration.
About Mavacamten
Mavacamten is a potential first-in-class, oral, allosteric modulator of cardiac myosin being investigated for the treatment of conditions caused by excessive cardiac contractility and impaired diastolic filling of the heart, including hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF).
In obstructive HCM specifically, it is the first and only selective cardiac myosin inhibitor that has the potential to target the underlying pathophysiology of the disease.
Mavacamten is an investigational therapy and is not approved for use in any country, for any indication.
About Eliquis
Eliquis is an oral selective Factor Xa inhibitor. By inhibiting Factor Xa, a key blood clotting protein, Eliquis decreases thrombin generation and blood clot formation. Eliquis is approved for multiple indications in the
ELIQUIS Important Safety Information
Indications
ELIQUIS is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
ELIQUIS is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.
ELIQUIS is indicated for the treatment of DVT and PE, and to reduce the risk of recurrent DVT and PE following initial therapy.
Important Safety Information
WARNING: (A) PREMATURE DISCONTINUATION OF ELIQUIS INCREASES THE RISK OF THROMBOTIC EVENTS, (B) SPINAL/EPIDURAL HEMATOMA
(A) Premature discontinuation of any oral anticoagulant, including ELIQUIS, increases the risk of thrombotic events. If anticoagulation with ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
(B) Epidural or spinal hematomas may occur in patients treated with ELIQUIS who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:
- use of indwelling epidural catheters
- concomitant use of other drugs that affect hemostasis, such as nonsteroidal
- anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
- a history of traumatic or repeated epidural or spinal punctures
- a history of spinal deformity or spinal surgery
- optimal timing between the administration of ELIQUIS and neuraxial procedures is not known
Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.
Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated.
CONTRAINDICATIONS
- Active pathological bleeding
- Severe hypersensitivity reaction to ELIQUIS (e.g., anaphylactic reactions)
WARNINGS AND PRECAUTIONS
- Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including ELIQUIS, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from ELIQUIS to warfarin in clinical trials in atrial fibrillation patients. If ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
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Bleeding Risk: ELIQUIS increases the risk of bleeding and can cause serious, potentially fatal, bleeding.
- Concomitant use of drugs affecting hemostasis increases the risk of bleeding, including aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, and NSAIDs.
- Advise patients of signs and symptoms of blood loss and to report them immediately or go to an emergency room. Discontinue ELIQUIS in patients with active pathological hemorrhage.
- The anticoagulant effect of apixaban can be expected to persist for at least 24 hours after the last dose (i.e., about two half-lives). An agent to reverse the anti-factor Xa activity of apixaban is available. Please visit www.andexxa.com for more information on availability of a reversal agent.
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Spinal/Epidural Anesthesia or Puncture: Patients treated with ELIQUIS undergoing spinal/epidural anesthesia or puncture may develop an epidural or spinal hematoma which can result in long-term or permanent paralysis.
The risk of these events may be increased by the postoperative use of indwelling epidural catheters or the concomitant use of medicinal products affecting hemostasis. Indwelling epidural or intrathecal catheters should not be removed earlier than 24 hours after the last administration of ELIQUIS. The next dose of ELIQUIS should not be administered earlier than 5 hours after the removal of the catheter. The risk may also be increased by traumatic or repeated epidural or spinal puncture. If traumatic puncture occurs, delay the administration of ELIQUIS for 48 hours.
Monitor patients frequently and if neurological compromise is noted, urgent diagnosis and treatment is necessary. Physicians should consider the potential benefit versus the risk of neuraxial intervention in ELIQUIS patients.
- Prosthetic Heart Valves: The safety and efficacy of ELIQUIS have not been studied in patients with prosthetic heart valves and is not recommended in these patients.
- Acute PE in Hemodynamically Unstable Patients or Patients who Require Thrombolysis or Pulmonary Embolectomy: Initiation of ELIQUIS is not recommended as an alternative to unfractionated heparin for the initial treatment of patients with PE who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.
- Increased Risk of Thrombosis in Patients with Triple Positive Antiphospholipid Syndrome (APS): Direct-acting oral anticoagulants (DOACs), including ELIQUIS, are not recommended for use in patients with triple-positive APS. For patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti–beta 2-glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy.
ADVERSE REACTIONS
- The most common and most serious adverse reactions reported with ELIQUIS were related to bleeding.
TEMPORARY INTERRUPTION FOR SURGERY AND OTHER INTERVENTIONS
- ELIQUIS should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding. ELIQUIS should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be noncritical in location and easily controlled. Bridging anticoagulation during the 24 to 48 hours after stopping ELIQUIS and prior to the intervention is not generally required. ELIQUIS should be restarted after the surgical or other procedures as soon as adequate hemostasis has been established.
DRUG INTERACTIONS
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Combined P-gp and Strong CYP3A4 Inhibitors: Inhibitors of P-glycoprotein (P-gp) and cytochrome P450 3A4 (CYP3A4) increase exposure to apixaban and increase the risk of bleeding. For patients receiving ELIQUIS doses of 5 mg or 10 mg twice daily, reduce the dose of ELIQUIS by
50% when ELIQUIS is coadministered with drugs that are combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, or ritonavir). In patients already taking 2.5 mg twice daily, avoid coadministration of ELIQUIS with combined P-gp and strong CYP3A4 inhibitors.
Clarithromycin
Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration with ELIQUIS.
- Combined P-gp and Strong CYP3A4 Inducers: Avoid concomitant use of ELIQUIS with combined P-gp and strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John’s wort) because such drugs will decrease exposure to apixaban.
- Anticoagulants and Antiplatelet Agents: Coadministration of antiplatelet agents, fibrinolytics, heparin, aspirin, and chronic NSAID use increases the risk of bleeding. APPRAISE-2, a placebo-controlled clinical trial of apixaban in high-risk post-acute coronary syndrome patients treated with aspirin or the combination of aspirin and clopidogrel, was terminated early due to a higher rate of bleeding with apixaban compared to placebo.
PREGNANCY
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The limited available data on ELIQUIS use in pregnant women are insufficient to inform drug-associated risks of major birth defects, miscarriage, or adverse developmental outcomes. Treatment may increase the risk of bleeding during pregnancy and delivery, and in the fetus and neonate.
- Labor or delivery: ELIQUIS use during labor or delivery in women who are receiving neuraxial anesthesia may result in epidural or spinal hematomas. Consider use of a shorter acting anticoagulant as delivery approaches.
LACTATION
- Breastfeeding is not recommended during treatment with ELIQUIS.
FEMALES AND MALES OF REPRODUCTIVE POTENTIAL
- Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician. The risk of clinically significant uterine bleeding, potentially requiring gynecological surgical interventions, identified with oral anticoagulants including ELIQUIS should be assessed in these patients and those with abnormal uterine bleeding.
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