Acoramidis Associated With Fewer Hospitalizations Than Tafamidis in ATTR-CM Study

Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) who started acoramidis had a lower rate of a composite clinical outcome than those who started tafamidis in a retrospective electronic health record study presented at the Heart Failure Society of America (HFSA) 2026 Annual Scientific Meeting. Differences in hospitalization and diuretic intensification drove the association, and the investigators urged caution in interpreting the findings.

Using the Epic COSMOS data platform, researchers identified patients who initiated either treatment from December 1, 2024, through October 31, 2025. They applied exclusion criteria to an initial group of 14,925 patients, leaving an analytical cohort of 4,051. They then matched patients on 21 baseline characteristics, producing a primary cohort of 2,684—910 who received acoramidis and 1,774 who received tafamidis.

The researchers used time-to-event models to assess a composite of death, hospitalization, new-onset atrial fibrillation, or diuretic intensification. They also examined each outcome separately. The presentation defined diuretic intensification as parenteral loop diuretic use, initiation or dose-equivalent escalation of an oral loop diuretic, or use of a thiazide-like diuretic.

The composite outcome favored acoramidis (hazard ratio [HR], 0.82; 95% CI, 0.73–0.93; P < .01). All-cause hospitalization (HR, 0.75; 95% CI, 0.64–0.88), cardiovascular hospitalization (HR, 0.73; 95% CI, 0.62–0.86), heart failure–specific hospitalization (HR, 0.73; 95% CI, 0.62–0.87), and diuretic intensification (HR, 0.83; 95% CI, 0.71–0.95) also favored acoramidis. The investigators found no statistically significant difference between groups in death or new-onset atrial fibrillation.

Mean follow-up was 299 days in the acoramidis group and 312.4 days in the tafamidis group. Although the matched characteristics had standardized mean differences below 0.1, mean B-type natriuretic peptide levels among patients with available measurements differed between groups: 839.5 pg/mL with acoramidis and 1294.0 pg/mL with tafamidis (P = .006).

The investigators said the results require replication and additional survival analysis. The presentation reported only human data; it included no animal findings or proposed biomarker validation.

Reference

Lanfear D, Littleton S. Real world comparative effectiveness study of acoramidis versus tafamidis in transthyretin amyloid cardiomyopathy using the Epic COSMOS data platform. Presented at: Heart Failure Society of America 2026 Annual Scientific Meeting; October 11, 2026; Phoenix, AZ.