About this trial
The MaesTTRo study aims to enroll a global cohort of patients with transthyretin (ATTR) amyloidosis to longitudinally observe the natural course of the disease and describe real-world treatment patterns and outcomes. In addition, information on the effectiveness of ATTR amyloidosis treatments, including eplontersen, which is a ligand-conjugated antisense oligonucleotide gene silencing treatment targeting activity against both the mutant and wild-type TTR protein, will be collected.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patient willing and able to provide written informed consent to participate in the study
Confirmed diagnosis of amyloid transthyretin (ATTR) amyloidosis
Aged ≥18 years at the time of signing the informed consent
Patient willing and able to participate in collection of electronic patient reported outcomes (PROs)
Disqualifiers
Concurrent participation in any interventional trial for ATTR amyloidosis
Involvement in the planning and/or conduct of the current study
Patients with evidence of primary or light chain amyloidosis (AL) or serum protein A amyloidosis (AA)
Asymptomatic patients with ATTR amyloidosis and asymptomatic ATTR mutation carriers
Trial population
Patients with a diagnosis of amyloid transthyretin (ATTR) amyloidosis
Trial design
Cohort
Prospective
Treatments tested in this trial
Treatment of transthyretin (ATTR) amyloidosis in observational study setting
DrugData will be collected on patients with ATTR amyloidosis in a real-world setting
Treatment groups
Trial outcomes
Primary outcomes
Demographic characteristics (overall and in patients initiating a treatment with eplontersen)
* Age * Sex as determined by the investigator (male/female) * Race and ethnicity, where allowed
Treatment patterns (overall and in patients initiating a treatment with eplontersen)
In order to address this objective, the following treatments will be assessed: * ATTR amyloidosis treatment: Tafamidis, Diflunisal, Acoramidis, Vutrisiran, Patisiran, Inotersen, Eplontersen, Doxycycline and taurodesoxycholic acid, Liver transplant * Heart failure/arrhythmia-related treatment: Diuretics, Angiotensin converting enzyme inhibitor, Angiotensin receptor blocker, Angiotensin receptor-neprilysin inhibitor, Anticoagulation, Beta-blockers, Sodium-glucose co-transporter-2 inhibitor, Mineralocorticoid receptor antagonist, Digoxin, Pacemaker use, Implantable cardioverter-defibrillator, Left ventricular assist device, Cardiac transplant, Transcatheter aortic valve replacement, Surgical aortic valve replacement * Polyneuropathy-related treatment: Antiepileptics (gabapentin, pregabalin, carbamazepine, phenytoin), Antidepressants, Topical pain treatments, Opioids, Tetrahydrocannabinol * Other: Medications for gastrointestinal symptoms, Vitamin A supplementation, Dialysis
Clinical characteristics (overall and in patients initiating a treatment with eplontersen)
In order to address this objective, the following clinical characteristics will be assessed: * Modified body mass index (mBMI) * Medical history * TTR genetic test results * Family history of ATTR * Time period between the first symptoms to date of diagnosis of ATTR * Time since diagnosis of ATTR
Findings from biopsy (overall and in patients initiating a treatment with eplontersen)
In order to address this objective, the following biopsy information will be collected: * Type of biopsy * Amyloid identification result (Positive, Negative, Inconclusive for amyloid) * Method of amyloid typing * Result of the biopsy (Normal/Abnormal) * Reason for considering the biopsy result abnormal
Secondary outcomes
Comparison of demographic and clinical characteristics of patients prescribed eplontersen at any time during the observation period to patients on other ATTR treatments
The following outcomes will be compared between patients treated with eplontersen and patients on other ATTR treatments: * Demographics * mBMI * Medical history * Family history of ATTR amyloidosis * Time period between the first symptoms to date of diagnosis of ATTR amyloidosis * Time since diagnosis of ATTR amyloidosis
Comparison of findings from biopsy in patients prescribed eplontersen at any time during the observation period to patients on other ATTR treatments
The following outcomes will be compared between patients treated with eplontersen and patients on other ATTR treatments: * Type of biopsy * Amyloid identification result (Positive, Negative, Inconclusive for amyloid) * Method of amyloid typing * Result of the biopsy (Normal/Abnormal) * Reason for considering the biopsy result abnormal
Comparison of findings from Cardiovascular magnetic resonance imaging (CMR) in patients prescribed eplontersen at any time during the observation period to patients on other ATTR treatments
The following outcomes will be compared between patients treated with eplontersen and patients on other ATTR treatments: extracellular volume (ECV), contrast use, left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, LV Mass Index, interventricular wall thickness, right ventricular Free Wall Thickness, LV Free Wall Thickness, left Atrial Volume Index, native T1 mapping, CMR result (Normal/Abnormal), reason for considering the result abnormal.
Comparison of findings from Echocardiography in patients prescribed eplontersen at any time during the observation period to patients on other ATTR treatments
The following outcomes will be compared between patients treated with eplontersen and patients on other ATTR treatments: LV ejection fraction, LV End Diastolic Volume, LV End Systolic Volume LV End Diastolic Dimension, LV End Systolic Dimension, Interventricular Septal, Thickness Diastole, Posterial Wall Thickness Diastole, Left Ventricular Mass Index, Left Atrial Volume, Left Atrial Volume Index, Mitral valve regurgitation, Aortic valve regurgitation, Tricuspid valve regurgitation, Pulmonic valve regurgitation, LV Outflow Gradient, Stroke Volume, Lateral early diastolic myocardial velocity (e' lateral), Medial early diastolic myocardial velocity (e' medial), Mitral E/e' Ratio, Early diastolic mitral inflow velocity (E), Late diastolic mitral inflow velocity (A), Mitral Peak E/A Ratio, Global LV longitudinal strain, Pulmonary artery systolic pressure, RV Free Wall Thickness Severity of Aortic stenosis, Severity of Mitral stenosis.
Other outcomes
Risk factors for worsening ATTR progression
Factors associated with changes in clinical manifestations of ATTR amyloidosis, NYHA classification, NAC ATTR staging or Mayo staging, FAP (Coutinho) staging, PND score, LVEF, CCI and CCI components, and other comorbidities of interest will be identified.
Healthcare costs in patients with ATTR amyloidosis
Average annual costs will be calculated based on available data in the different countries.
Serious adverse events in patients treated with ATTR amyloidosis treatments
Serious adverse events in patients treated with ATTR amyloidosis treatments will be measured
Sponsors and contacts
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AstraZeneca
Lead sponsor
ICON plc
Collaborator