Tafamidis can improve survival in octogenarian patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a recently published study in the European Heart Journal.
The study’s authors aimed to determine if there are any significant differences in treatment response between octogenarians and younger patients because patients over 80 were underrepresented in recent clinical trials studying tafamidis.
“Although octogenarians represent the majority of ATTRwt-CM patients evaluated in the real world, the recent ATTR-ACT trial and LTE study included a limited number of 44 octogenarian patients only on active tafamidis meglumine 80 mg (bioequivalent to currently approved tafamidis free acid 61 mg) treatment and excluded nonagenarians,” the authors wrote.
The study used clinical data from five supraregional heart centers in Europe. Their search yielded 710 patients with ATTR-CM diagnosed between 2010 and 2023. Approximately 58% of the total sample were octogenarians.
The authors observed that octogenarians and non-octogenarians had similar echocardiographic characteristics and similar blood biomarker alterations. However, patients over 80 tended to have more severe symptoms and functional limitations.
Tafamidis therapy increased survival at any age
257 patients did not receive tafamidis. The median estimated survival for patients in this natural-course cohort was approximately four years. Untreated octogenarians had a significantly higher one-year and five-year mortality rate (16% and 71%, respectively) than untreated non-octogenarians (8% and 47%).
The treatment cohort had very different results than the natural-course cohort. Tafamidis reduced three-year mortality by more than half of the overall population. After dividing the population according to age, researchers noted that the over 50% reduction in mortality also applied to octogenarians.
An extensive statistical analysis of the results revealed that tafamidis improves survival irrespective of age.
Read more about ATTR-CM therapies
Octogenarians were less likely to receive tafamidis
Non-octogenarians were more likely to receive tafamidis than octogenarians (84% vs 79%). Octogenarians appeared to have larger intervals between diagnosis and treatment initiation. Furthermore, disease progression in octogenarians was more advanced at the time of treatment initiation.
“Treatment initiation and discontinuation, specifically in octogenarians, need to be well balanced and result from a more challenging integration of treatment efficacy and complex biological factors (comorbidities, polypharmacy, frailty, mobility, and cognition) that co-determine outcome, at the verge of debatable cost-effectiveness of (tafamidis) treatment in patients with intrinsically limited lifespan,” the authors concluded.
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