Abstract |
Tafamidis is a transthyretin (TTR) stabilizer able to prevent TTR tetramer dissociation. There have been a few encouraging studies on Tafamidis efficacy in early-onset inherited transthyretin amyloidosis (ATTR) due to Val30Met mutation. However, less is known about its efficacy in later disease stages and in non-Val30Met mutations. We performed a multi-center observational study on symptomatic ATTR patients prescribed to receive Tafamidis. We followed up patients according to a standardized protocol including general medical, cardiological and neurological assessments at baseline and every 6 months up to 3 years. Sixty-one (42 males) patients were recruited. Only 28 % of enrolled subjects had the common Val30Met mutation, mean age of onset was remarkably late (59 years) and 18 % was in advanced disease stage at study entry. Tafamidis proved safe and well-tolerated. One-third of patients did not show significant progression along 36 months, independently from mutation type and disease stage. Neurological function worsened particularly in the first 6 months but progression slowed significantly thereafter. Autonomic function remained stable in 33 %, worsened in 56 % and improved in 10 %. Fifteen percent of patients showed cardiac disease progression and 30 % new onset of cardiomyopathy. Overall, Tafamidis was not able to prevent functional progression of the disease in 23 (43 %) subjects, including 16 patients who worsened in their walking ability and 12 patients who reached a higher NYHA score during the follow-up period. A higher mBMI at baseline was associated with better preservation of neurological function. In conclusion, neuropathy and cardiomyopathy progressed in a significant proportion of patients despite treatment. However, worsening of neurological function slowed after the first 6 months and also subjects with more advanced neuropathy, as well as patients with non-Val30Met mutation, benefited from treatment. Body weight preservation is an important favorable prognostic factor.
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Authors | A Cortese, G Vita, M Luigetti, M Russo, G Bisogni, M Sabatelli, F Manganelli, L Santoro, T Cavallaro, G M Fabrizi, A Schenone, M Grandis, C Gemelli, A Mauro, L G Pradotto, L Gentile, C Stancanelli, A Lozza, S Perlini, G Piscosquito, D Calabrese, A Mazzeo, L Obici, D Pareyson |
Journal | Journal of neurology
(J Neurol)
Vol. 263
Issue 5
Pg. 916-924
(May 2016)
ISSN: 1432-1459 [Electronic] Germany |
PMID | 26984605
(Publication Type: Journal Article, Multicenter Study, Observational Study)
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Chemical References |
- Benzoxazoles
- Prealbumin
- tafamidis
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Amyloid Neuropathies, Familial
(diagnosis, drug therapy, genetics)
- Benzoxazoles
(adverse effects, therapeutic use)
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Italy
- Longitudinal Studies
- Male
- Middle Aged
- Mutation
- Prealbumin
(genetics)
- Prognosis
- Severity of Illness Index
- Treatment Outcome
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