Efficacy and Safety of Acoramidis in Transthyretin Amyloid Cardiomyopathy.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
11 Jan 2024
11 Jan 2024
Historique:
medline:
10
1
2024
pubmed:
10
1
2024
entrez:
10
1
2024
Statut:
ppublish
Résumé
Transthyretin amyloid cardiomyopathy is characterized by the deposition of misfolded monomeric transthyretin (TTR) in the heart. Acoramidis is a high-affinity TTR stabilizer that acts to inhibit dissociation of tetrameric TTR and leads to more than 90% stabilization across the dosing interval as measured ex vivo. In this phase 3, double-blind trial, we randomly assigned patients with transthyretin amyloid cardiomyopathy in a 2:1 ratio to receive acoramidis hydrochloride at a dose of 800 mg twice daily or matching placebo for 30 months. Efficacy was assessed in the patients who had an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m A total of 632 patients underwent randomization. The primary analysis favored acoramidis over placebo (P<0.001); the corresponding win ratio was 1.8 (95% confidence interval [CI], 1.4 to 2.2), with 63.7% of pairwise comparisons favoring acoramidis and 35.9% favoring placebo. Together, death from any cause and cardiovascular-related hospitalization contributed more than half the wins and losses to the win ratio (58% of all pairwise comparisons); NT-proBNP pairwise comparisons yielded the highest ratio of wins to losses (23.3% vs. 7.0%). The overall incidence of adverse events was similar in the acoramidis group and the placebo group (98.1% and 97.6%, respectively); serious adverse events were reported in 54.6% and 64.9% of the patients. In patients with transthyretin amyloid cardiomyopathy, the receipt of acoramidis resulted in a significantly better four-step primary hierarchical outcome containing components of mortality, morbidity, and function than placebo. Adverse events were similar in the two groups. (Funded by BridgeBio Pharma; ATTRibute-CM ClinicalTrials.gov number, NCT03860935.).
Sections du résumé
BACKGROUND
BACKGROUND
Transthyretin amyloid cardiomyopathy is characterized by the deposition of misfolded monomeric transthyretin (TTR) in the heart. Acoramidis is a high-affinity TTR stabilizer that acts to inhibit dissociation of tetrameric TTR and leads to more than 90% stabilization across the dosing interval as measured ex vivo.
METHODS
METHODS
In this phase 3, double-blind trial, we randomly assigned patients with transthyretin amyloid cardiomyopathy in a 2:1 ratio to receive acoramidis hydrochloride at a dose of 800 mg twice daily or matching placebo for 30 months. Efficacy was assessed in the patients who had an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m
RESULTS
RESULTS
A total of 632 patients underwent randomization. The primary analysis favored acoramidis over placebo (P<0.001); the corresponding win ratio was 1.8 (95% confidence interval [CI], 1.4 to 2.2), with 63.7% of pairwise comparisons favoring acoramidis and 35.9% favoring placebo. Together, death from any cause and cardiovascular-related hospitalization contributed more than half the wins and losses to the win ratio (58% of all pairwise comparisons); NT-proBNP pairwise comparisons yielded the highest ratio of wins to losses (23.3% vs. 7.0%). The overall incidence of adverse events was similar in the acoramidis group and the placebo group (98.1% and 97.6%, respectively); serious adverse events were reported in 54.6% and 64.9% of the patients.
CONCLUSIONS
CONCLUSIONS
In patients with transthyretin amyloid cardiomyopathy, the receipt of acoramidis resulted in a significantly better four-step primary hierarchical outcome containing components of mortality, morbidity, and function than placebo. Adverse events were similar in the two groups. (Funded by BridgeBio Pharma; ATTRibute-CM ClinicalTrials.gov number, NCT03860935.).
Identifiants
pubmed: 38197816
doi: 10.1056/NEJMoa2305434
doi:
Banques de données
ClinicalTrials.gov
['NCT03860935']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
132-142Investigateurs
Christopher Hayward
(C)
Noemi Horvath
(N)
Dariusz Korczyk
(D)
Kaitlyn Lam
(K)
David Russell
(D)
Stephen Bek Ngie Ting
(SBN)
Philippe Debonnaire
(P)
Riet Dierckx
(R)
Matthias Dupont
(M)
Philippe Jr Timmermans
(PJ)
Johan Van Cleemput
(J)
Fabio Fernandes
(F)
Paulo Leães
(P)
Roberto Sant'Anna
(R)
Pedro Schwartzmann
(P)
Tonnison Silva
(T)
Fabian Alejandro Azzari
(FA)
Margot Davis
(M)
Diego Delgado
(D)
Anique Ducharme
(A)
Nowell Fine
(N)
Doug Hayami
(D)
Gordon Moe
(G)
Frederic Poulin
(F)
Francois Tournoux
(F)
Shelley Zieroth
(S)
Jan Krejci
(J)
Milos Kubanek
(M)
Tomas Palecek
(T)
Steen Hvitfeldt Poulsen
(SH)
Efstathios Kastritis
(E)
Emer Joyce
(E)
Kenneth McDonald
(K)
Michael Arad
(M)
Arthur Pollak
(A)
Leonardo Bolognese
(L)
Francesco Cappelli
(F)
Samuela Carigi
(S)
Michele Emdin
(M)
Laura Obici
(L)
Christian Knackstedt
(C)
Marish Oerlemans
(M)
Peter van der Meer
(P)
Hugh Goodman
(H)
Timothy Sutton
(T)
Ewa Jankowska
(E)
Jacek Grzybowski
(J)
João Agostinho
(J)
Teresa Coelho
(T)
Antoni Bayes-Genis
(A)
Pablo Garcia-Pavia
(P)
José Gonzalez-Juanatey
(J)
Ramón Lecumberri Villamediana
(R)
Julio Nuñez
(J)
Tomás Ripoll Vera
(T)
Dong-Ju Choi
(DJ)
Seung-Pyo Lee
(SP)
Julian Gillmore
(J)
Marianna Fontana
(M)
Jorg Taubel
(J)
Olakunle Akinboboye
(O)
Craig Alpert
(C)
Amrut Ambardekar
(A)
John Berk
(J)
Kunal Bhatt
(K)
Mirnela Byku
(M)
Richard Cheng
(R)
Noel Dasgupta
(N)
Brian Drachman
(B)
J Emanuel Finet
(JE)
Mazen Hanna
(M)
Cesia Gallegos
(C)
Robert Gordon
(R)
Justin Grodin
(J)
Martha Grogan
(M)
Jason Guichard
(J)
James Hoffman
(J)
Sandeep Jani
(S)
Michael Johnstone
(M)
Daniel Judge
(D)
Saurabh Kapoor
(S)
Michel Khouri
(M)
Catherine Marti
(C)
Ahmad Masri
(A)
Mathew Maurer
(M)
Joshua Mitchell
(J)
Sumeet Mitter
(S)
Deirdre Mooney
(D)
Jignesh Patel
(J)
Alex Reyentovich
(A)
Nitasha Sarswat
(N)
John Schmedtje
(J)
Keyur Shah
(K)
Sanjiv Shah
(S)
Farooq Sheikh
(F)
Prem Soman
(P)
Brett Sperry
(B)
Josef Stehlik
(J)
David Stern
(D)
James Tauras
(J)
Richard Wright
(R)
Alejandra Gonzalez-Duarte
(A)
Matthew S Maurer
(MS)
Renato Lopes
(R)
Simon Gibbs
(S)
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