As reported on Cardiovascular Business, new long-term findings presented at the American College of Cardiology (ACC) 2026 meeting provide compelling evidence that early and continuous treatment with acoramidis (Attruby) confers sustained survival benefits for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). The data extend outcomes from the pivotal ATTRibute-CM trial to as long as 54 months, offering one of the longest follow-up assessments for a transthyretin stabilizer in this population.
The late-breaking analysis came from the open-label extension of the original randomized trial. Patients who initially received acoramidis and remained on therapy experienced markedly better long-term outcomes compared with those who began on placebo before crossing over to active treatment. According to Prem Soman, MD, director of the Cardiac Amyloidosis Center at the University of Pittsburgh Medical Center, the separation between treatment groups persisted over time, highlighting the consequences of delayed intervention.
The extension data demonstrated meaningful reductions in both overall mortality and cardiovascular-related hospitalizations among patients treated early with acoramidis. Importantly, individuals who started therapy later did not fully recover the prognostic ground lost during the placebo phase. This pattern reinforces a central challenge in cardiac amyloidosis care: once structural and functional damage develops, it is largely irreversible.
“These findings illustrate why early diagnosis is critical,” Soman noted. “Waiting to initiate therapy places patients at a permanent disadvantage.”
A Transformative Decade for Cardiac Amyloidosis Care
Soman also emphasized how dramatically the amyloidosis landscape has shifted in recent years. Once considered a rare and frequently missed condition, ATTR-CM is now understood to be far more prevalent—particularly the wild-type form—and can often be diagnosed without the need for invasive cardiac biopsy. Noninvasive radionuclide imaging has become a cornerstone of detection, enabling broader screening and earlier recognition.
The availability of multiple disease-modifying therapies has further accelerated this shift. In addition to acoramidis, tafamidis is approved as a transthyretin stabilizer, while the gene-silencing agent amvuttra offers another treatment pathway. Together, these options have transformed ATTR-CM from a largely untreatable condition into one where sustained clinical benefit is achievable.
Clinicians are encouraged to maintain a high index of suspicion in heart failure patients with unexplained ventricular thickening, especially when accompanied by red-flag conditions such as bilateral carpal tunnel syndrome or lumbar spinal stenosis. As the extension data underscore, prompt diagnosis and early initiation of therapy are essential—because in cardiac amyloidosis, lost time cannot be regained.
