Heart failure & cardiomyopathiesSecondary analysis
Early Increase in Serum Transthyretin by Acoramidis Independently Predicts Improved Survival in TTR Amyloid Cardiomyopathy
- Secondary analysis of the ATTRibute-CM randomised trial
- phase 3
Authors' conclusion
Acoramidis-mediated early ΔTTR is independently associated with improved survival after adjusting for known predictors.
Study context
- Population
- Participants with ATTR-CM from the ATTRibute-CM study population
- Participants
- 557 participants
- Comparison
- Early change in sTTR with acoramidis and association with all-cause mortality
- Primary endpoint
- Association of early change in sTTR (day 28) with all-cause mortality
- Follow-up
- 30 months
Primary result
All-cause mortality by early ΔTTR (day 28)
Hazard ratio
0.96
95% CI 0.93–0.98
P = 0.002
Early ΔTTR (per 1 mg/dL increase)
HR 0.96 (95% CI 0.93–0.98); P = 0.002
Per 1 mg/dL increase, as printed
As reported in the abstract
- Early ΔTTR independently associated with reduced all-cause mortality in multivariate analysis (adjusted for TTR variant, NYHA class, NAC stage, baseline sTTR)
- P < 0.001
- Early ΔTTR fully mediates acoramidis effect on all-cause mortality: average causal mediation effect
- −0.117
- Average direct effect
- 0.0366
- Predicted relative reduction in odds of all-cause mortality per 5 mg/dL increase in sTTR (logistic model)
- 31.6%
Further findings
- Early rise in sTTR with acoramidis within 28 days · 28 days, sustained through 30 months
- 9.1 · mean · mg/dL
Overall survival by baseline sTTR ≥20 vs <20 mg/dL
- Greater overall survival with baseline sTTR ≥20 mg/dL than <20 mg/dL
- P < 0.0001
Early ΔTTR and all-cause mortality by treatment
- Association with reduced all-cause mortality with acoramidis; no such association with placebo
Original publication
Early Increase in Serum Transthyretin by Acoramidis Independently Predicts Improved Survival in TTR Amyloid Cardiomyopathy. J Am Coll Cardiol. Published 27 May 2025. doi:10.1016/j.jacc.2025.03.542
Summarised from the published abstract; every number is checked against it