Natriuretic Peptide and Transthyretin and Their Relationship With Clinical Outcomes: Results From ATTRIBUTE‐CM, a Randomized Controlled Trial
Key result
Acoramidis reduces mortality and CV hospitalization regardless of baseline NT-proBNP and sTTR levels.
- n=632
Why the study?
Are baseline NT-proBNP and sTTR prognostic for clinical outcomes, and does acoramidis reduce these outcomes regardless of biomarker status in patients with transthyretin amyloid cardiomyopathy?
Population
632 participants with transthyretin amyloid cardiomyopathy (ATTR-CM)
Comparison
Acoramidis vs Placebo
Design
RCT, randomized, double-blind, placebo-controlled
Follow-up
through Month 30
Authors
Discussion
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Implication
Acoramidis reduces mortality and CV hospitalization risks across NT-proBNP/sTTR strata in ATTR-CM; confirms their additive prognostic value.
Key Points
- To evaluate the relationship between baseline NT-proBNP and serum transthyretin levels and determine their combined prognostic value for clinical outcomes in transthyretin amyloid cardiomyopathy.
- Post hoc analysis of the phase 3, randomized, double-blind, placebo-controlled ATTRIBUTE-CM trial (N=632; NCT03860935) evaluating acoramidis versus placebo.
- Assessed baseline NT-proBNP and serum transthyretin concentrations for correlations with clinical status and subsequent time to all-cause mortality/first cardiovascular hospitalization and cardiovascular mortality/first cardiovascular hospitalization through Month 30.
- Higher baseline NT-proBNP and lower serum transthyretin were inversely correlated and were each independently associated with all-cause mortality/first cardiovascular hospitalization and cardiovascular mortality/first cardiovascular hospitalization in multivariable Cox models.
- The combination of high baseline NT-proBNP and low serum transthyretin identified patients at the highest risk and shortest time to adverse events.
- Acoramidis consistently reduced the risk of all-cause mortality/first cardiovascular hospitalization and cardiovascular mortality/first cardiovascular hospitalization across all baseline biomarker levels and disease stages.
Study Design
Type
RCT (n=632)
Blinding
Double-blind
Randomization
randomized
Structured PICO
Are baseline NT-proBNP and sTTR prognostic for clinical outcomes, and does acoramidis reduce these outcomes regardless of biomarker status in patients with transthyretin amyloid cardiomyopathy?
P
Population
632 participants with transthyretin amyloid cardiomyopathy randomized to acoramidis or placebo, followed through Month 30.
I
Intervention
Acoramidis
C
Comparator
Placebo
O
Outcome
Time to all-cause mortality (ACM)/first cardiovascular hospitalization (CVH) and cardiovascular mortality (CVM)/first CVH through Month 30composite
Baseline NT-proBNP and sTTR are additively prognostic in ATTR-CM, and acoramidis maintains its clinical efficacy across different biomarker profiles.
Limitations
- post hoc analysis
Cite This Study
Ilonze et al. (2026) conducted an RCT in Transthyretin amyloid cardiomyopathy (ATTR-CM) (n=632). Acoramidis vs. Placebo was evaluated on All-cause mortality/first cardiovascular hospitalization and cardiovascular mortality/first cardiovascular hospitalization. Baseline NT-proBNP and sTTR were additively prognostic for mortality and cardiovascular hospitalization, and acoramidis reduced these risks regardless of baseline biomarker status.