Efficacy of tafamidis in transthyretin amyloid cardiomyopathy: a systematic review and meta-analysis

Abstract

In May 2019, the U.S. Food and Drug Administration approved tafamidis as the first conservative management of transthyretin amyloid cardiomyopathy (ATTR-CM). Our aim in conducting this systematic review and meta-analysis was to assess the efficacy of tafamidis on patients with ATTR-CM. For that purpose, we thoroughly searched PubMed, ScienceDirect, and Clinical trails.gov by using the appropriate search strategy and following predefined inclusion and exclusion criteria, which retrieved 235 articles initially. Of which two randomized controlled trials (RCTs) and one observational study matched our inclusion criteria. A total of 876 patients are included in this analysis. Based on results, tafamidis significantly reduced cardiovascular (CV) mortality in the ATTR-ACT trial and Ochi et al. (OR 0.58; 95% CI: [0.41–0.83], P=0.003, I 2=87%). A subgroup analysis was conducted for CV mortality due to heart failure (OR 0.89; 95% CI: [0.63–1.25], P=0.50, I 2=93%). The results exhibit that tafamidis reduced all causes of mortality (OR 0.45; 95% CI: [0.32–0.64], P≤0.00001, I 2=22%). Furthermore, mortality remained statistically insignificant in patients with heart transplants (OR 1.18; 95% CI: [0.52–2.70], P=0.70, I 2=0%) and patients with cardiac mechanical assist devices (OR 4.15; 95% CI: [0.48–35.66], P=0.20, I 2=0%). This meta-analysis suggests that tafamidis is a safe and efficient drug to use in patients with ATTR-CM and can possess the potential to be a milestone in enhancing the conservative management of the patients.