Conference Coverage

Acoramidis Linked to NT-proBNP Recovery After Hospitalization in ATTR-CM

Edited by:
Brian McCurdy

Key Highlights

  • Cardiovascular hospitalization occurred in 26.7% of acoramidis recipients versus 42.6% of placebo recipients through month 30.
  • NT-proBNP levels increased in both groups during the 12 months before a first cardiovascular hospitalization.
  • After hospitalization, NT-proBNP levels declined with acoramidis but continued to increase with placebo.

Acoramidis was associated with improved N-terminal pro–B-type natriuretic peptide (NT-proBNP) recovery after cardiovascular hospitalization in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a post hoc analysis of ATTRibute-CM. The abstract was presented at the American Heart Association Scientific Sessions 2026.

NT-proBNP is a biomarker of cardiac stress and a predictor of cardiovascular hospitalization and death in ATTR-CM, according to the abstract. Investigators examined its trajectory around hospitalization to characterize changes with acoramidis versus placebo.

In the phase 3 ATTRibute-CM trial, participants were randomized 2:1 to receive acoramidis hydrochloride 800 mg or placebo twice daily for 30 months. This analysis evaluated geometric mean NT-proBNP levels in the modified intention-to-treat population, comparing participants with at least 1 cardiovascular hospitalization against those without an event.

Among participants with a hospitalization, investigators assessed log₂-transformed NT-proBNP levels from 12 months before through 12 months after the first event. Participants who died without cardiovascular hospitalization were excluded. A piecewise linear mixed-effects model accounted for treatment, hospitalization frequency, time to first hospitalization, time before and after the event, treatment interactions, and randomization stratification factors.

Study Findings

The modified intention-to-treat population included 409 acoramidis recipients and 202 placebo recipients. Through month 30, 26.7% of acoramidis recipients and 42.6% of placebo recipients experienced at least 1 cardiovascular hospitalization. Acoramidis also lowered the annualized hospitalization rate, with a relative risk ratio of 0.50 (95% CI, 0.36–0.70; P < .0001).

Across pooled treatment groups, participants who experienced at least 1 cardiovascular hospitalization (n=195) had higher NT-proBNP levels at baseline and throughout the study than those without hospitalization (n=416). Mean levels increased in both treatment groups during the 12 months preceding the first event. During the subsequent 12 months, levels declined with acoramidis, with a slope (standard error) of −0.034 (0.012), but continued to increase with placebo, with a slope of 0.025 (0.014). The between-group difference in slopes was significant (P = .0015).

Clinical Implications

According to the study authors, acoramidis reduced cardiovascular hospitalization and was associated with improved NT-proBNP recovery following hospitalization compared with placebo. Their conclusion describes recovery in this biomarker after a cardiovascular hospitalization event.

Expert Commentary

“In the ATTRibute-CM trial conducted in participants with ATTR-CM, acoramidis not only reduced CVH, but was associated with improved NT-proBNP recovery post-CVH compared with placebo,” the researchers concluded.

Reference

Soman P, Griffin J, Stern LK, et al. Recovery after cardiovascular hospitalization in transthyretin amyloid cardiomyopathy (ATTR-CM): insights from an N-terminal pro-B-type natriuretic peptide (NT-proBNP) analysis of the ATTRibute-CM study. Abstract Su1031. Presented at: American Heart Association Scientific Sessions 2026; November 8, 2026.