[en] [en] INTRODUCTION: Hereditary transthyretin amyloidosis (hATTRv) is a rare, genetic, adult-onset, multisystemic disorder which can affect diverse organs, including peripheral nerves, heart, kidneys, gastrointestinal tract, liver, skin and eyes. Currently, several disease-modifying treatments for hATTRv are available in Belgium including the TTR stabilizer tafamidis and TTR mRNA silencers patisiran and vutrisiran. Patisiran contains a small interfering RNA encapsulated into a lipid nanoparticle to deliver to hepatocytes, the main source of TTR protein production, thereby reducing TTR production.
METHODS: We report and discuss five cases of hATTRv in different clinical scenarios that were successfully managed with patisiran, highlighting our real-world clinical practice.
RESULTS: These cases illustrate that patisiran is effective to improve mild symptoms and stabilize the moderate ones. The cases also highlight the importance of red flags recognition to allow early diagnosis and treatment to prevent further disease progression.
CONCLUSION: Due to the multisystemic nature of the disease and its heterogeneous clinical presentation, close collaboration between neurologists and cardiologists is highly recommended, ideally within a multidisciplinary amyloidosis team, to provide holistic care in hATTRv patients.
Disciplines :
Neurology
Author, co-author :
DELSTANCHE, Stéphanie ; Centre Hospitalier Universitaire de Liège - CHU > > Service de neurologie (CHR)
Claeys, Kristl G ; Department of Neurology, University Hospitals Leuven, Leuven, Belgium ; Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KULeuven, and Leuven Brain Institute (LBI), Leuven, Belgium
De Bleecker ; Department of Neurology, University Hospital Ghent and AZ Sint-Lucas General Hospital, Ghent, Belgium
Remiche, Gauthier ; Centre de Référence Neuromusculaire, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Service de Neurologie, Brussels, Belgium
Troisfontaines, Pierre ; Department of Cardiology, CHR Citadelle, Liège, Belgium
Van Parys, Vinciane ; Department of Neurology, Saint-Luc University Hospitals, Université Catholique de Louvain (UCL), Brussels, Belgium
Bondue, Antoine ; Department of Cardiology, Hôpital universitaire de Bruxelles, CUB Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
Language :
English
Title :
Phenotype variability and therapeutic response to Patisiran in patients with hereditary transthyretin amyloidosis: a Belgian real-world experience.
Martens B, De Pauw M, De Bleecker JL., Single-centre experience on transthyretin familial amyloid polyneuropathy: case series and literature review. Acta Neurol Belg. 2018;118:179–185. doi: 10.1007/s13760-018-0906-z
Poli L, Labella B, Cotti Piccinelli S, et al. Hereditary transthyretin amyloidosis: a comprehensive review with a focus on peripheral neuropathy. Front Neurol. 2023;14:1242815. doi: 10.3389/fneur.2023.1242815
Kristen AV, Ajroud-Driss S, Conceição I, et al. Patisiran, an RNAi therapeutic for the treatment of hereditary transthyretin-mediated amyloidosis. Neurodegener Dis Manag. 2019;9(1):5–23. doi: 10.2217/nmt-2018-0033
Coelho T, Maurer MS, Suhr OB. THAOS–the transthyretin amyloidosis outcomes survey: initial report on clinical manifestations in patients with hereditary and wild-type transthyretin amyloidosis. Curr Med Res Opin. 2013;29(1):63–76. doi: 10.1185/03007995.2012.754348
Gentile L, Coelho T, Dispenzieri A, et al. A 15-year consolidated overview of data in over 6000 patients from the transthyretin amyloidosis outcomes survey (THAOS). Orphanet J Rare Dis. 2023;18:350. doi: 10.1186/s13023-023-02962-5
Dohrn MF, Auer-Grumbach M, Baron R, et al. Chance or challenge, spoilt for choice? New recommendations on diagnostic and therapeutic considerations in hereditary transthyretin amyloidosis with polyneuropathy: the German/Austrian position and review of the literature. J Neurol. 2021;268:3610–3625. doi: 10.1007/s00415-020-09962-6
Ando Y, Coelho T, Berk JL, et al. Guideline of transthyretin-related hereditary amyloidosis for clinicians. Orphanet J Rare Dis. 2013;8:31. doi: 10.1186/1750-1172-8-31
Wixner J, Mundayat R, Karayal ON, et al. THAOS: gastrointestinal manifestations of transthyretin amyloidosis - common complications of a rare disease. Orphanet J Rare Dis. 2014;9(1):61. doi: 10.1186/1750-1172-9-61
Solignac J, Delmont E, Fortanier E, et al. Kidney involvement in hereditary transthyretin amyloidosis: a cohort study of 103 patients. Clin Kidney J. 2022;15:1747–1754. doi: 10.1093/ckj/sfac118
Ando Y, Adams D, Benson MD, et al. Guidelines and new directions in the therapy and monitoring of ATTRv amyloidosis. Amyloid. 2022; 1–13. doi: 10.1080/13506129.2022.2052838
Adams D, Koike H, Slama M, et al. Hereditary transthyretin amyloidosis: a model of medical progress for a fatal disease. Nat Rev Neurol. 2019;15:387–404. doi: 10.1038/s41582-019-0210-4
Nativi-Nicolau JN, Karam C, Khella S, et al. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2022;27:785–793. doi: 10.1007/s10741-021-10080-2
Warner AL. Advances in the treatment of transthyretin cardiac amyloidosis: current and emerging therapies. Pharmacother: The J Hum Pharmacol Drug Ther. 2021;41:1081–1091. doi: 10.1002/phar.2639
Russo M, Gentile L, Toscano A, et al. Advances in treatment of ATTRv Amyloidosis: state of the art and future prospects. Brain Sci. 2020;10(12):952. doi: 10.3390/brainsci10120952
Carvalho A, Rocha A, Lobato L. Liver transplantation in transthyretin amyloidosis: issues and challenges. Liver Transpl. 2015;21:282–292. doi: 10.1002/lt.24058
David A, Gonzalez-Duarte Alejandra OWD, O’Riordan WD, et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis. N Engl J Med. 2018;379(1):11–21. doi: 10.1056/NEJMoa1716153
Quan D, Obici L, Berk JL, et al. Impact of baseline polyneuropathy severity on patisiran treatment outcomes in the APOLLO trial. Amyloid. 2023;30:49–58. doi: 10.1080/13506129.2022.2118043
Adams D, Polydefkis M, González-Duarte A, et al. Long-term safety and efficacy of patisiran for hereditary transthyretin-mediated amyloidosis with polyneuropathy: 12-month results of an open-label extension study. Lancet Neurol. 2021;20(1):49–59. doi: 10.1016/S1474-4422(20)30368-9
Maurer MS, Kale P, Fontana M, et al. Patisiran treatment in patients with transthyretin cardiac amyloidosis. N Engl J Med. 2023;389(17):1553–1565. doi: 10.1056/NEJMoa2300757
Conceição I, Damy T, Romero M, et al. Early diagnosis of ATTR amyloidosis through targeted follow-up of identified carriers of TTR gene mutations. Amyloid. 2019;26:3–9. doi: 10.1080/13506129.2018.1556156
Casasnovas C, Lladó L, Borrachero C, et al. A narrative review and expert recommendations on the assessment of the clinical manifestations, follow-up, and management of post-olt patients with ATTRv amyloidosis. Ther Adv Neurol Disord. 2023;16:17562864231191590. doi: 10.1177/17562864231191590
Schmidt HH, Wixner J, Planté-Bordeneuve V, et al. Patisiran treatment in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy after liver transplantation. Am J Transplant. 2022;22(6):1646–1657. doi: 10.1111/ajt.17009
Mazzeo A, Munoz-Beamud F, Coelho T, et al. Patisiran in patients with hATTR amyloidosis post-orthopedic liver transplant: 12-month results. J Neurol Sci. 2021;429. doi: 10.1016/j.jns.2021.118371
Suhr O, Å D, Holmgren G, et al. Malnutrition and gastrointestinal dysfunction as prognostic factors for survival in familial amyloidotic polyneuropathy. J Intern Med. 1994;235(5):479–485. doi: 10.1111/j.1365-2796.1994.tb01106.x
Gonzalez-Duarte A. Autonomic involvement in hereditary transthyretin amyloidosis (hATTR amyloidosis). Clin Auton Res. 2019;29:245–251. doi: 10.1007/s10286-018-0514-2
Barroso FA, Coelho T, Dispenzieri A, et al. Characteristics of patients with autonomic dysfunction in the transthyretin amyloidosis outcomes survey (THAOS). Amyloid. 2022;29:175–183. doi: 10.1080/13506129.2022.2043270
Garcia-Pavia P, Rapezzi C, Adler Y, et al. Diagnosis and treatment of cardiac amyloidosis. A position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur J Heart Fail. 2021;23(4):512–526. doi: 10.1002/ejhf.2140
Maurer MS, Schwartz JH, Gundapaneni B, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med. 2018;379(11):1007–1016. doi: 10.1056/NEJMoa1805689
Gillmore Julian D, Judge Daniel P, Francesco C, et al. Efficacy and safety of acoramidis in transthyretin amyloid cardiomyopathy. N Engl J Med. 2024;390(2):132–142. doi: 10.1056/NEJMoa2305434
Van den Bergh PY, Hadden RD, Bouche P, et al. European federation of neurological societies/peripheral nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the european federation of neurological societies and the peripheral nerve society - first revision. Eur J Neurol. 2010;17(3):356–363. doi: 10.1111/j.1468-1331.2009.02930.x
Adams D, Ando Y, Beirão JM, et al. Expert consensus recommendations to improve diagnosis of ATTR amyloidosis with polyneuropathy. J Neurol. 2021;268:2109–2122. doi: 10.1007/s00415-019-09688-0
Debonnaire P, Claeys M, De Paepe P, et al. Prospective screening for transthyretin cardiac amyloidosis in spinal stenosis surgery patients. JACC: CardioOncology. 2023;5:836–838. doi: 10.1016/j.jaccao.2023.05.012
Eldhagen P, Berg S, Lund LH, et al. Transthyretin amyloid deposits in lumbar spinal stenosis and assessment of signs of systemic amyloidosis. J Intern Med. 2021;289:895–905. doi: 10.1111/joim.13222
Maurer MS, Fontana M, Berk J, et al. Primary results from Apollo-b, a phase 3 study of patisiran in patients with transthyretin-mediated amyloidosis with cardiomyopathy. J Card Fail. 2023;29:550. doi: 10.1016/j.cardfail.2022.10.013
Milandri A, Farioli A, Gagliardi C, et al. Carpal tunnel syndrome in cardiac amyloidosis: implications for early diagnosis and prognostic role across the spectrum of aetiologies. Eur J Heart Fail. 2020;22(3):507–515. doi: 10.1002/ejhf.1742
Sekijima Y, Ueda M, Koike H, et al. Diagnosis and management of transthyretin familial amyloid polyneuropathy in Japan: red-flag symptom clusters and treatment algorithm. Orphanet J Rare Dis. 2018;13(1):6. doi: 10.1186/s13023-017-0726-x
Carroll A, Dyck PJ, de Carvalho M, et al. Novel approaches to diagnosis and management of hereditary transthyretin amyloidosis. J Neurol Neurosurg Psychiatry. 2022;93:668–678. doi: 10.1136/jnnp-2021-327909
De Bleecker JL, Claeys KG, Delstanche S, et al. A retrospective survey of patients with hereditary transthyretin-mediated (hATTR) amyloidosis treated with patisiran in real-world clinical practice in Belgium. Acta Neurol Belg. 2023;123:1029–1037. doi: 10.1007/s13760-023-02188-z
Damy T, Shah Z, Drachman B, et al. Evaluation of disease progression in patients with ATTR amyloidosis with cardiomyopathy following treatment with patisiran: post-hoc analysis of the APOLLO-B study. Eur Heart J. 2023;44(Supplement_2):ehad655.996. doi: 10.1007/10.1093/eurheartj/ehad655.996