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?
NT-proBNP and serum TTR are prognostic biomarkers in transthyretin amyloid cardiomyopathy, but their combined value for integrated risk stratification remains unknown.
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 randomized in ATTRIBUTE-CM
Comparison
Acoramidis vs placebo
Design
Post hoc analysis of a phase 3 randomized double-blind placebo-controlled trial
Follow-up
Through Month 30
Authors
Discussion
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Member takes
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.