Tafamidis: A game changer in transthyretin cardiomyopathy? A systematic review and meta-analysis of safety and efficacy.

PURPOSE: Tafamidis was FDA-approved for Transthyretin cardiomyopathy (ATTR-CM) due to its demonstrated reduction in mortality and hospitalizations.

METHODS

976 studies from PubMed and Embase were screened. Seven studies were included that compared tafamidis treatment with no tafamidis for ATTR-CM. The mantel-Haenszel method was used for binary outcomes, and Hedges' g was used for continuous outcomes.

RESULTS

Tafamidis was associated with decreased odds of mortality (OR 0.55, 95 % CI 0.42-0.73, I2=41 %, p<0.0001) and reduced CHF exacerbations (OR 0.71, 95 % CI 0.51-0.99, I2= 0 %, p= 0.04). While, CHF related hospitalizations (OR 0.35, 95 % CI 0.07-1.67, I2= 87 %, p= 0.19), atrial arrhythmias (OR 0.98, 95 % CI 0.67-1.42, I2= 0 %, p= 0.9), change in left ventricular ejection fraction (SMD 0.87, 95 % CI -0.37-2.11, I2=98 %, p= 0.17), left ventricular end-diastolic diameter from baseline (SMD -0.12, 95 % CI -0.41-0.18, I2= 0 %, p= 0.4), interventricular septal thickness from baseline (SMD -0.7, 95 % CI -1.57-0.17, I2= 96 %, p= 0.11) were not statistically different for tafamidis compared to no tafamidis for ATTR-CM.

CONCLUSION

Tafamidis treatment in ATTR-CM is associated with reduced all-cause mortality and a lower incidence of CHF exacerbations. These observations are consistent with the ATTRACT trial, which supports the efficacy of tafamidis in treating ATTR-CM.