Early realworld use of acoramidis insights from the german starTTR cohort

Background

The TTR stabilizer acoramidis has recently been approved for the treatment of amyloid transthyretin cardiomyopathy (ATTR-CM) in Europe on 10 Feb 2025, yet little is known about who receives this therapy in routine care or switches from the stabilizer tafamidis.

Purpose

To characterize patients with ATTR-CM initiating acoramidis in German routine care settings.

Methods

The IQVIATM LRx database includes longitudinal information on, among others, type and dose of prescribed drugs and date of prescription. It covers ~80% of persons insured in the statutory health insurance system thus allowing to analyze outpatient prescription claims over time. From this database, we identified patients with at least one acoramidis prescription between April and September 2025. Sociodemographic and clinical characteristics, concomitant medications and prescribers were analyzed overall, and stratified by treatment-naïve initiators versus patients switching from tafamidis defined as presence or absence of any tafamidis 61mg prescription since March 2020 (post-approval of tafamidis) and prior to acoramidis initiation.

Results

During the 6-month period since the launch of acoramidis in April 2025, initiation of acoramidis was observed in 289 patients: median age 82 years (Q1-Q3: 77-85), 15% women. Of those initiating acoramidis, 86% were treatment-naïve, while 14% switched from tafamidis.

Initiation occurred predominantly in the hospital outpatient setting (87%), though less frequently among switchers than naïve initiators (78% vs 88%).

In the 12 months prior to acoramidis, patients commonly received sodium-glucose co-transporter-2 inhibitors (SGLT2i; 74%), beta-blockers (71%), loop diuretics (64%), and oral anticoagulants (60%). Those switching from tafamidis to acoramidis were less likely to be taking renin-angiotensin system inhibitors (60% vs 79%), mineralocorticoid receptor antagonists (30% vs 38%), SGLT2i (68% vs 75%), and analgesics (33% vs 42%) than treatment-naïve patients.

Use of co-medications remained largely stable in the three months after acoramidis initiation, with only a slight increase in SGLT2i prescribing (61% to 69%).

Conclusion

This analysis highlights key characteristics of patients initiating acoramidis early after its launch in Germany. The study population is predominantly male and older. Acoramidis was mainly utilized for treatment-naive patients but also serves as an option for switching within the same drug class. Co-medication regarding heart failure and cardiac comorbidities in these patients is well developed. These findings provide a baseline for monitoring subsequent real-world implementation, adherence, effectiveness and safety of acoramidis in routine clinical practice in Germany.Table 1:patient characteristicsFor image description, please refer to the figure legend and surrounding text.Table 2:Use of co-medicationsFor image description, please refer to the figure legend and surrounding text.