Acoramidis in transthyretin amyloid cardiomyopathy: expanding evidence from ATTRibute-CM

Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. TTR stabilizers bind directly to TTR, inhibiting tetramer dissociation and the resulting amyloidogenic process. This comprehensive review synthesizes clinical outcomes data from the ATTRibute-CM study program, including primary analyses, prespecified sensitivity studies, and open-label extension (OLE) follow-up, to characterize the clinical profile of acoramidis, an oral TTR stabilizer approved for ATTR-CM treatment. In clinical trials, acoramidis demonstrated consistent clinical benefits, with statistically significant reductions in the composite of all-cause mortality or first cardiovascular-related hospitalization evident within 3 months and sustained through 30 months. Prespecified analyses confirmed treatment robustness. Efficacy was maintained regardless of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds (≥500 pg/mL, ≥750 pg/mL, and ≥1000 pg/mL), was unaffected by concomitant tafamidis use, and was similar in high-risk participants with stage 4 chronic kidney disease (CKD), who are typically excluded from clinical trials. OLE studies through 42 months showed sustained benefits with no new safety concerns. Results demonstrate robust clinical benefits of acoramidis across diverse ATTR-CM populations and across NYHA classes and NAC stages, independent of NT-proBNP thresholds, concomitant tafamidis use, or high-risk CKD. An ongoing prevention study in asymptomatic ATTR-CM gene-mutation carriers may further expand its therapeutic range for ATTR management.