ATTR-CM Impact

ATTR-CM is a life-threatening progressive heart
condition
that negatively impacts patients1-3

Actor portrayals.

ATTR-CM can present in 2 forms that differ
in onset and severity of disease

Wild-type ATTR-CM (ATTRwt-CM)4:

  • Caused by TTR destabilization due to aging
  • Typically presents later in life but often remains undiagnosed for years

Variant ATTR-CM (ATTRv-CM)5:

  • Caused by TTR gene mutations
  • May present earlier; associated with faster disease progression and more aggressive cardiac disease
  • V122I is a common variant that occurs in 1 in 25 Black Americans
Actor portrayals.
Actor portrayals.

Without early intervention, ATTR-CM may lead to1,6:

  • Earlier mortality
  • Increased CV-related hospitalizations
  • Significantly impaired quality of life
  • Reduced functional capacity

ATTR-CM can be challenging to recognize and diagnose7,8

ATTR-CM can present as a variety of cardiac and extracardiac symptoms

  • Shortness of breath
  • Swelling in legs and feet

  • Gastrointestinal problems info

  • Tiredness or weakness
  • Irregular heartbeat
  • Carpal tunnel syndrome

ATTR-CM is prevalent in patients
with certain comorbidities,
including but not limited to8,9:

  • 16% aortic stenosis with value replacement
  • 13%-15% HFpEF
discover-signs-image

Symptoms can mirror other serious conditions or appear
unrelated to a
heart condition

Tracking markers of progression can inform timely interventions10

In a real-world, retrospective, observational cohort study from May 2018 to October 2022

Patients showed signs of ATTR-CM progression as defined by:

Worsening biomarkers

  • NT-proBNP
  • eGFR

Declining outcomes

  • Cardiac worsening
  • CV-related hospitalization

Identify signs and symptoms of
ATTR-CM12,13

The following list can help you better understand how ATTR-CM
and its
symptoms present

Clinical clues from routine
cardiac evaluation that should prompt
additional diagnostic evaluation for ATTR-CM

Neurological Symptoms

Neurological Symptoms:

  • Sensorimotor polyneuropathy (paresthesias and weakness)
  • Autonomic dysfunction (orthostatic hypotension, postprandial diarrhea alternating with constipation, gastroparesis, urinary retention, and incontinence)
Orthopedic Symptoms

Orthopedic Symptoms:

  • Carpal tunnel syndrome
  • Lumbar spinal stenosis
  • Unprovoked biceps tendon rupture
  • Hip and knee arthroplasty
Neurological Symptoms

Hereditary Factors:

  • Family history of cardiomyopathy
  • Family history of polyneuropathy
  • Black race
  • Irish descent
  • Portuguese descent
Diagnostic Factors

Diagnostic Factors:

  • Persistent low-level elevation in
    serum troponin
  • Discordance between QRS voltage on an ECG and wall thickness on imaging
  • Unexplained atrioventricular block or prior pacemaker implantation
  • Unexplained left ventricular wall thickening, right ventricular thickening, or atrial wall thickening
  • Intolerance to antihypertensive or heart failure medications because of symptomatic hypotension or orthostasis

ATTR-CM=transthryretin amyloid cardiomyopathy; ECG=electrocardiogram.

Explore additional resources to
learn
more about variant ATTR-CM

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ATTR-CM=transthyretin amyloid cardiomyopathy; ATTRv=variant transthyretin-mediated amyloidosis; ATTRwt=wild-type transthyretin-mediated amyloidosis; CV=cardiovascular; eGFR=estimated glomerular
filtration rate; HFpEF=heart failure with preserved ejection fraction;
NT-proBNP=N-terminal pro–B-type natriuretic peptide; TTR=transthyretin.

References: 1. Stewart M, Shaffer S, Murphy B, et al. Characterizing the high disease burden of transthyretin amyloidosis for patients and caregivers. Neurol Ther. 2018;7(2):349-364. doi:10.1007/s40120-018-0106-z 2. Gertz MA, Benson MD, Dyck PJ, et al. Diagnosis, prognosis, and therapy of transthyretin amyloidosis. J Am Coll Cardiol. 2015;66(21):2451-2466. doi:10.1016/j.jacc.2015.09.075 3. Lane T, Fontana M, Martinez-Naharro A, et al. Natural history, quality of life, and outcome in cardiac transthyretin amyloidosis. Circulation. 2019;140(1):16-26. doi:10.1161/CIRCULATIONAHA.118.038169 4. Hornstrup LS, Frikke-Schmidt R, Nordestgaard BG, Tybjaerg-Hansen A. Genetic stabilization of transthyretin, cerebrovascular disease, and life expectancy. Arterioscler Thromb Vasc Biol. 2013;33(6):1441-1447. doi:10.1161/ATVBAHA.113.301273 5. Quarta CC, Buxbaum JN, Shah AM, et al. The amyloidogenic V122I transthyretin variant in elderly black Americans. N Engl J Med. 2015;372(1):21-29. doi:10.1056/NEJMoa1404852 6. Lauppe R, Liseth Hansen J, Fornwall A, et al. Prevalence, characteristics, and mortality of patients with transthyretin amyloid cardiomyopathy in the Nordic countries. ESC Heart Fail. 2022;9(4):2528-2537. doi:10.1002/ehf2.13961 7. Rozenbaum MH, Large S, Bhambri R, et al. Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review. Cardiol Ther. 2021;10(1):141-159. doi:10.1007/s40119-021-00219-5 8. Kittleson MM, Ruberg FL, Ambardekar AV, et al. 2023 ACC expert consensus decision pathway on comprehensive multidisciplinary care for the patient with cardiac amyloidosis: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81(11):1076-1126. doi:10.1016/j.jacc.2022.11.022 9. Kim MM, Prasad M, Burton Y, et al. Comparative outcomes of a transthyretin amyloid cardiomyopathy cohort versus patients with heart failure with preserved ejection fraction enrolled in the TOPCAT Trial. J Am Heart Assoc. 2023;12(15):e029705. doi:10.1161/JAHA.123.029705 10. Fontana M, Kumar V, Sheridan P, et al. Descriptive analysis of unmet need in a contemporary cohort of tafamidis-treated patients with ATTR-CM. Poster presented at: Heart Failure Society of America Annual Scientific Meeting; September 27-30, 2024; Atlanta, GA. 11. Wixner J, Mundayat R, Karayal ON, Anan I, Karling P, Suhr OB. THAOS: gastrointestinal manifestations of transthyretin amyloidosis - common complications of a rare disease. Orphanet J Rare Dis. 2014;9(1):61. doi:10.1186/1750-1172-9-61 12. Kittleson MM, Maurer MS, Ambardekar AV, et al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2020;142(1):e7-e22. doi:10.1161/CIR.0000000000000792 13. Vanhentenrijk S, Grodin JL, Augusto SN Jr, et al. Hereditary transthyretin cardiac amyloidosis with the p.V142I variant: mechanistic insights and diagnostic challenges. Circ Heart Fail. 2025;18(6):e012469. doi:10.1161/CIRCHEARTFAILURE.124.012469 14. Hammarström P, Jiang X, Hurshman AR, Powers ET, Kelly JW. Sequence-dependent denaturation energetics: a major determinant in amyloid disease diversity. Proc Natl Acad Sci USA. 2002;99(suppl 4):16427-16432. doi:10.1073/pnas.202495199

TTR stability impacts disease severity14

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*T119M is a protective, naturally occurring stabilizing variant of TTR.14

†Compared with wild-type.

ATTR=transthyretin amyloidosis; TTR=transthyretin; wt=wild-type.

Experienced by 15% of patients with ATTRwt and 63% of patients with ATTRv.11

Indication and Important safety information

INDICATION

Attruby® (acoramidis) is indicated for the treatment of the cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis (ATTR-CM) in adults to reduce cardiovascular death and cardiovascular-related hospitalization.

IMPORTANT SAFETY INFORMATION

Adverse Reactions
Diarrhea (11.6% vs 7.6%) and upper abdominal pain (5.5% vs 1.4%) were reported in patients treated with Attruby versus placebo, respectively. The majority of these adverse reactions were mild and resolved without drug discontinuation.

Discontinuation rates due to adverse events were similar between patients treated with Attruby versus placebo (9.3% and 8.5%, respectively).

Laboratory Tests
Mean increase in serum creatinine of 0.2 and 0.0 mg/dL and a mean decrease in eGFR of 8.2 and 0.7 mL/min/1.73 m2 was observed in the adults with ATTR-CM treated with Attruby versus placebo, respectively, at Day 28 and then stabilized. These changes were reversible after treatment discontinuation.

Use in Specific Populations

Pregnancy & Lactation: There are no data on the use of Attruby in pregnant women. Animal data have not shown developmental risk associated with the use of Attruby in pregnancy. There are no available data on the presence of Attruby in either human or animal milk or the effects of the drug on the breastfed infant or maternal milk production.

Please see Full Prescribing Information including Patient Information.

INDICATION AND IMPORTANT
SAFETY INFORMATION

INDICATION

Attruby® (acoramidis) is indicated for the treatment of the cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis (ATTR-CM) in adults to reduce cardiovascular death and cardiovascular-related hospitalization.

IMPORTANT SAFETY INFORMATION

Adverse Reactions
Diarrhea (11.6% vs 7.6%) and upper abdominal pain (5.5% vs 1.4%) were reported in patients treated with Attruby versus placebo, respectively. The majority of these adverse reactions were mild and resolved without drug discontinuation.

Discontinuation rates due to adverse events were similar between patients treated with Attruby versus placebo (9.3% and 8.5%, respectively).

Laboratory Tests
Mean increase in serum creatinine of 0.2 and 0.0 mg/dL and a mean decrease in eGFR of 8.2 and 0.7 mL/min/1.73 m2 was observed in the adults with ATTR-CM treated with Attruby versus placebo, respectively, at Day 28 and then stabilized. These changes were reversible after treatment discontinuation.

Use in Specific Populations

Pregnancy & Lactation: There are no data on the use of Attruby in pregnant women. Animal data have not shown developmental risk associated with the use of Attruby in pregnancy. There are no available data on the presence of Attruby in either human or animal milk or the effects of the drug on the breastfed infant or maternal milk production.

Please see Full Prescribing Information including Patient Information.