Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy.

Abstract

BACKGROUND:

Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial).

METHODS:

Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE.

RESULTS:

Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44-0.79]; P<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33-0.99]; P=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43-0.87]; P=0.006); and baseline New York Heart Association class I and II (0.56 [0.38-0.82]; P=0.003) and class III (0.65 [0.41-1.01]; P=0.06).

CONCLUSIONS:

In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01994889 and NCT02791230.

• Authors: Perry Elliott, Brian M Drachman, Stephen S Gottlieb, James E Hoffman, Scott L Hummel, Daniel J Lenihan, Ben Ebede, Balarama Gundapaneni, Benjamin Li, Marla B Sultan, Sanjiv J Shah
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 15 Issue 1 Pg. e008193 (01 2022) ISSN: 1941-3297 [Electronic] United States
• PMID: 34923848 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Benzoxazoles
• Prealbumin
• tafamidis

Topics

• Aged
• Aged, 80 and over
• Amyloid Neuropathies, Familial (complications, drug therapy, mortality)
• Benzoxazoles (pharmacology)
• Cardiomyopathies (complications, drug therapy, mortality)
• Female
• Heart Failure (complications, drug therapy, mortality)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Prealbumin (pharmacology)
• Proportional Hazards Models
• Time