Conference Coverage

Acoramidis Reduced the Risk of Recurrent Hospitalization in ATTR-CM

Edited by:
Brian McCurdy

Key Highlights

  • Acoramidis significantly reduced the risk of first cardiovascular-related hospitalization vs placebo.
  • Risks of recurrent hospitalization and death after a first hospitalization were numerically lower, but confidence intervals included 1.
  • The post hoc analysis used multistate modeling to account for competing events over 30 months.

Acoramidis reduced the risk of first cardiovascular-related hospitalization (CVH) and showed favorable trends toward lower risks of recurrent CVH and subsequent all-cause mortality in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a post hoc ATTRibute-CM analysis. The abstract is being presented at the American Heart Association Scientific Sessions 2026 on November 8.

The phase 3 ATTRibute-CM trial randomized participants 2:1 to acoramidis hydrochloride 800 mg or placebo twice daily for 30 months. This analysis included the intention-to-treat population: 421 acoramidis recipients and 211 placebo recipients. Researchers examined the risk of subsequent CVH and all-cause mortality after an initial CVH.

An illness-death model characterized disease progression as a joint process of hospitalization and mortality, treating CVH as a nonterminal event and death as a terminal event. The model accounted for competing events and evaluated transitions from study entry to first CVH, between successive hospitalizations, and from hospitalization to death. Treatment effects were estimated using transition-specific hazard ratios.

Study Findings

A first CVH occurred in 113 acoramidis recipients (26.8%) and 90 placebo recipients (42.7%). A second CVH occurred in 41 (9.7%) and 40 (19.0%), respectively, while 23 (5.5%) and 22 (10.4%) experienced at least 3 CVH events.

In multistate modeling, acoramidis significantly reduced the risk of transitioning from study entry to first CVH compared with placebo (hazard ratio [HR], 0.53; 95% CI, 0.40–0.70; P < .001). Among participants who experienced a first CVH, acoramidis was associated with numerically lower risks of recurrent CVH (HR, 0.62; 95% CI, 0.37–1.04) and all-cause mortality after first CVH (HR, 0.60; 95% CI, 0.31–1.17).

Clinical Implications

According to the study authors, conventional time-to-event analyses provide an incomplete assessment of treatment effects on dynamic risk over time. This analysis evaluated how acoramidis affected subsequent event risk after an initial hospitalization while accounting for competing events such as death.

The authors interpreted the results as supporting the hypothesis that acoramidis benefits persist as patients’ risk trajectories change following previous events. Their conclusion distinguished the lower risk of first CVH from favorable trends in recurrent CVH and mortality after first CVH.

Expert Commentary

“These data support the hypothesis that clinical benefits of acoramidis persist despite changing risk trajectories based on past events,” the researchers concluded.

Reference

Grodin J, Alexander KM, Judge DP, et al. Risk of multiple cardiovascular-related hospitalizations and of all-cause mortality in transthyretin amyloid cardiomyopathy: findings from ATTRibute-CM using multistate modeling. Abstract Su1032.Presented at: American Heart Association Scientific Sessions 2026; November 8, 2026.