Early real-world use of acoramidis for transthyretin amyloid cardiomyopathy in Germany: results from StarTTR

Acoramidis, a selective transthyretin stabilizer, received EU approval in February 2025 for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). We describe patient characteristics and comedication patterns in German routine care. Adults with ≥ 1 acoramidis dispensation between April and September 2025 were identified from the IQVIA™ Longitudinal Prescription database, which covers 82% of reimbursed prescriptions. Sociodemographic data, comorbidities, prescribing setting, and comedications were analyzed overall and by pretreatment status (treatment-naïve vs. tafamidis switchers). A total of 289 patients were identified; median age was 82 (interquartile range 77–85) years; 15% were female and 86% were treatment-naïve. Acoramidis initiation occurred predominantly in hospital outpatient departments (87%). In the year preceding initiation, the most common comedications were renin–angiotensin system (RAS) inhibitors (76%), sodium glucose cotransporter 2 (SGLT2) inhibitors (74%), and beta-blockers (71%). Between 12 and 10 months and 3 and 1 months before initiation, use of mineralocorticoid receptor antagonists (MRAs), loop diuretics, direct oral anticoagulants, and SGLT2 inhibitors increased markedly, whereas RAS inhibitors, beta-blockers, and calcium channel blockers remained unchanged. This real-world analysis showed that acoramidis was predominantly prescribed as first-line therapy for older, mainly male patients with ATTR-CM; switching from tafamidis was comparatively infrequent. The increasing use of MRAs, loop diuretics, direct oral anticoagulants, and SGLT2 inhibitors prior to acoramidis initiation is consistent with active therapeutic optimization in specialist centers. These data provide an early benchmark for monitoring acoramidis adoption and will inform future comparative effectiveness research.