Efficacy and safety of mavacamten in non-obstructive hypertrophic cardiomyopathy: A systematic review and meta-analysis of randomized trials

Background: Non-obstructive hypertrophic cardiomyopathy (nHCM) remains a therapeutic challenge, with limited pharmacological options beyond symptomatic management. Mavacamten, a selective allosteric cardiac myosin inhibitor, has shown benefit in obstructive HCM, but its role in nHCM is uncertain. Methods: ), New York Heart Association (NYHA) functional class, and treatment-emergent adverse events (TEAEs). Pooled mean differences (MDs) and risk ratios (RRs) were estimated using random- or fixed-effects models based on heterogeneity. Results: = 40.8%). Atrial fibrillation occurred more frequently with mavacamten (RR: 1.41; 95% CI: 1.28 to 1.56), whereas palpitations and dizziness did not differ significantly. Conclusions: Mavacamten does not significantly enhance symptoms, functional capacity, or health status in nHCM, though safety is comparable to placebo. Ongoing monitoring for arrhythmias and reduced ejection fraction is essential. Larger, longer-term studies are needed to clarify its role in this population.