For HCPs

About ATTR-CM

Diagnosing
ATTR-CM

Step 1

Identify

Symptoms

Symptoms can be easy to miss as they often mimic other conditions.1,2

Fatigue

Feeling tired even after resting

Dyspnea

Feeling winded even with light activity

Arrhythmia

Heart racing or skipping beats

Swelling in legs and feet

Heaviness & discomfort from fluid buildup

Carpal tunnel syndrome

Tingling or numbness in one or both hands

Gastrointestinal problems

Diarrhea alternating with constipation

Back pain

Stiffness & pain in the lower back

Nerve pain

Burning, tingling, or numbness in the hands, feet, or legs

Screening

Early screening for ATTR-CM can help reduce diagnostic delays.3

Characteristics that may indicate ATTR-CM, including older age, heart failure symptoms, and increased wall thickness

Testing

Timely diagnosis of ATTR-CM can inform treatment decisions.1,3

EKG – Used to help identify arrhythmias (including atrial fibrillation), conduction system diseases, and pseudoinfarct patterns5

Echocardiogram – Helps distinguish ATTR-CM from other causes of left ventricular wall thickness4

Cardiac Magnetic Resonance (CMR) – Useful for characterizing myocardial structure and tissue and helping understand the underlying etiology of CM4

Step 2

Exclude AL

Rule out AL-CM – Serum free light chain testing and serum and urine immunofixation are used to rule out AL, another type of cardiac amyloidosis4

Step 3

Confirm

Cardiac scintigraphy – Uses a radioactive tracer with SPECT or SPECT/CT imaging to detect tracer uptake in the heart that may indicate ATTR-CM4,7

Biopsy – An endomyocardial biopsy involves obtaining tissue samples from the heart, often from the interventricular septum4,8

Step 4

Type

Genetic Testing – Used to differentiate wild‑type ATTR‑CM from variant ATTR‑CM by identifying pathogenic TTR gene mutations following confirmation of ATTR cardiac amyloidosis4

AL-CM=light chain amyloid cardiomyopathy;
ATTR-CM=transthyretin amyloid cardiomyopathy; CMR=cardiac magnetic resonance; CT=computed tomography; EKG=electrocardiogram; SPECT=single-photon emission computed tomography; TTR=transthyretin.

References:

  1. Rozenbaum MH, Large S, Bhambri R, et al. Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review. Cardiol Ther. 2021;10(1):141-159. doi:10.1007/s40119-021-00219-5
  2. Kittleson MM, Ruberg FL; American College of Cardiology Solution Set Oversight Committee. 2023 ACC expert consensus decision pathway on comprehensive multidisciplinary care for the patient with cardiac amyloidosis. J Am Coll Cardiol. 2023;81(11):1076-1126. doi:10.1016/j.jacc.2022.11.022
  3. Nativi-Nicolau JN, Karam C, Khella S, Maurer MS. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2022;27:785-793. doi:10.1007/s10741-021-10080-2
  4. Witteles RM, Bokhari S, Damy T, et al. Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Heart Fail. 2019;7(8):709-716. doi:10.1016/j.jchf.2019.04.010
  5. Kittleson MM, Ambardekar AV, Cheng RK, et al. Transthyretin cardiac amyloidosis evaluation and management: 2025 ACC concise clinical guidance. J Am Coll Cardiol. 2026;87(5):549-565. doi:10.1016/j.jacc.2025.09.004
  6. Patel RK, Ioannou A, Razvi Y, et al. Sex differences among patients with transthyretin amyloid cardiomyopathy—from diagnosis to prognosis. Eur J Heart Fail. 2022;24(12):2355-2363. doi:10.1002/ejhf.2646
  7. Hanna M, Ruberg FL, Maurer MS, et al. Cardiac scintigraphy with technetium-99m-labeled bone-seeking tracers for suspected amyloidosis: JACC review topic of the week. J Am Coll Cardiol. 2020;75(22):2851-2862. doi:10.1016/j.jacc.2020.04.022
  8. Hahn VS, Yanek LR, Vaishnav J, et al. Endomyocardial biopsy characterization of heart failure with preserved ejection fraction and prevalence of cardiac amyloidosis. JACC Heart Fail. 2020;8(9):712-724. doi:10.1016/j.jchf.2020.04.007

Important Safety Information and Indication

Important Safety Information

Adverse Reactions
Diarrhea (11.6% vs 7.6%) and upper abdominal pain (5.5% vs 1.4%) were reported in patients treated with Attruby versus placebo, respectively. The majority of these adverse reactions were mild and resolved without drug discontinuation.
Discontinuation rates due to adverse events were similar between patients treated with Attruby versus placebo (9.3% and 8.5%, respectively).

Laboratory Tests
Mean increase in serum creatinine of 0.2 and 0.0 mg/dL and a mean decrease in eGFR of 8.2 and 0.7 mL/min/1.73 m2 was observed in the adults with ATTR-CM treated with Attruby versus placebo, respectively, at Day 28 and then stabilized. These changes were reversible after treatment discontinuation.

Use in Specific Populations

Pregnancy & Lactation: There are no data on the use of Attruby in pregnant women. Animal data have not shown developmental risk associated with the use of Attruby in pregnancy. There are no available data on the presence of Attruby in either human or animal milk or the effects of the drug on the breastfed infant or maternal milk production.

Indication

Attruby® (acoramidis) is indicated for the treatment of the cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis (ATTR-CM) in adults to reduce cardiovascular death and cardiovascular-related hospitalization.

Please see Full Prescribing Information including Patient Information.

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More information on DDIs1

Avoid concomitant use of Attruby (acoramidis) with UGT inducers and strong CYP3A inducers, as these can potentially decrease Attruby exposure.

Consider more frequent monitoring for evidence of increased exposure to CYP2C9 substrates when Attruby (acoramidis) is coadministered with sensitive CYP2C9 substrates.

CYP=cytochrome P450; DDI=drug-drug interaction; UGT=uridine diphosphate glucuronosyltransferase.

Established Safety Profile4

Patients With 1 or More Events Attruby
n=421, % (n)		 Placebo
n=211, % (n)
Any TEAEs 98.1% (413) 97.6% (206)
Any treatment-emergent SAEs 54.6% (230) 64.9% (137)
Any treatment-related TEAEs 11.9% (50) 5.2% (11)
Severe TEAEs 37.3% (157) 45.5% (96)

SAE=serious adverse event; TEAE=treatment-emergent adverse event.