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• W4283446906 abstract "HomeCirculation: Heart FailureVol. 15, No. 7Letter by Baldovino et al Regarding Article, “Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Baldovino et al Regarding Article, “Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy” Simone Baldovino, MD, Piera Costanzo, MD and Dario Roccatello, MD Simone BaldovinoSimone Baldovino https://orcid.org/0000-0002-4475-4117 CMID-Coordinating Center of Piedmont and Valle D’Aosta Network for Rare Diseases, ASL Città di Torino St G. Bosco Hub Hospital, Turin, Italy (S.B., P.C., D.R.). Department of Clinical and Biological Sciences, University of Turin, Italy (S.B., D.R.). Search for more papers by this author , Piera CostanzoPiera Costanzo CMID-Coordinating Center of Piedmont and Valle D’Aosta Network for Rare Diseases, ASL Città di Torino St G. Bosco Hub Hospital, Turin, Italy (S.B., P.C., D.R.). Search for more papers by this author and Dario RoccatelloDario Roccatello CMID-Coordinating Center of Piedmont and Valle D’Aosta Network for Rare Diseases, ASL Città di Torino St G. Bosco Hub Hospital, Turin, Italy (S.B., P.C., D.R.). Department of Clinical and Biological Sciences, University of Turin, Italy (S.B., D.R.). Search for more papers by this author Originally published24 Jun 2022https://doi.org/10.1161/CIRCHEARTFAILURE.122.009617Circulation: Heart Failure. 2022;15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 24, 2022: Ahead of Print To the Editor:In the study “Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy,” Elliott et al1 analyzed the 5-year survival of patients participating in the ATTR-ACT trial (Transthyretin Amyloidosis Cardiomyopathy Clinical Trial) and the following long-term extension.The authors extensively associate the different overall survival with variables, such as the presence of mutated or wild-type transthyretin, the New York Heart Association heart failure class at the baseline, and the assignment to the tafamidis or placebo arm during the trial.Similarly, to the ATTR-ACT trial,2 while the study reached its primary end points, it missed the opportunity to explore the possible heterogeneity in responses across different age subgroups.The Food and Drug Administration and the European Medicines Agency have approved tafamidis meglumine 61 mg to treat amyloidosis due to wild-type or mutated transthyretin in adult patients with cardiomyopathy without distinguishing between age or New York Heart Association classes.However, as highlighted in 2 recent studies in Italy and Japan, the diagnosis of wild-type transthyretin amyloidosis occurs predominately in subjects around 80 years old3,4 and based on previous studies, we can expect an even higher prevalence in over-octogenarians. What concrete advantages are to be expected in such an elderly population? At least a good general condition and an assumed life expectancy of 3 years should be set as reasonable limits to prescription.Having a registered medication for transthyretin amyloid cardiomyopathy is a tremendous achievement for the medical community. The challenge for the future is to urgently analyze if the efficacy and, more critically, the cost-benefit balance are confirmed across the different age groups, especially in the elderly populations. Future randomized controlled trials in the older population aiming to evaluate the actual clinical impact of tafamidis, the cardiological drug with the highest authorized cost,5 on survival and quality of life of patients with transthyretin amyloid cardiomyopathy are needed.Article InformationDisclosures None.FootnotesFor Disclosures, see page 739.References1. Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Li B, Sultan MB, Shah SJ. Long-term survival with tafamidis in patients with transthyretin amyloid cardiomyopathy.Circ Heart Fail. 2022; 15:e008193. doi: 10.1161/CIRCHEARTFAILURE.120.008193LinkGoogle Scholar2. Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, Kristen AV, Grogan M, Witteles R, Damy T, et al; ATTR-ACT Study Investigators. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy.N Engl J Med. 2018; 379:1007–1016. doi: 10.1056/NEJMoa1805689CrossrefMedlineGoogle Scholar3. Zampieri M, Nardi G, Del Monaco G, Allinovi M, Gabriele M, Zocchi C, Casagrande S, Fumagalli C, Di Mario C, Olivotto I, et al. Changes in the perceived epidemiology of amyloidosis: 20 year-experience from a tertiary referral centre in Tuscany.Int J Cardiol. 2021; 335:123–127. doi: 10.1016/j.ijcard.2021.04.023CrossrefMedlineGoogle Scholar4. Yamada T, Takashio S, Arima Y, Nishi M, Morioka M, Hirakawa K, Hanatani S, Fujisue K, Yamanaga K, Kanazawa H, et al. Clinical characteristics and natural history of wild‐type transthyretin amyloid cardiomyopathy in Japan.Esc Hear Fail. 2020; 7:2829–2837. doi: 10.1002/ehf2.12884CrossrefMedlineGoogle Scholar5. Dobner S. Letter regarding the article ‘efficacy and safety of tafamidis doses in the tafamidis in transthyretin cardiomyopathy clinical trial (ATTR-ACT) and long-term extension study’.Eur J Heart Fail. 2021; 23:681–682. doi: 10.1002/ejhf.2049CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2022Vol 15, Issue 7 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.122.009617PMID: 35748294 Originally publishedJune 24, 2022 PDF download Advertisement" @default.
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