Acoramidis Linked to Fewer Hospitalizations Than Tafamidis in ATTR-CM

Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) who started acoramidis had an 18% lower risk of a composite of death, all-cause hospitalization, new-onset atrial fibrillation, or diuretic intensification than those who started tafamidis, according to a retrospective electronic health record (EHR) study presented at the Heart Failure Society of America (HFSA) Annual Scientific Meeting 2026.¹

The analysis, conducted and presented by David Lanfear, MD, MS, of Henry Ford Health, used Epic COSMOS, which BridgeBio describes as the largest US EHR database, with more than 300 million patients. BridgeBio markets acoramidis as Attruby and calls the study independent. Full results are under peer review at a journal.

Hospitalization Risk Ran About 25% Lower With Acoramidis

Investigators identified patients who began a transthyretin stabilizer from December 1, 2024, through October 31, 2025. After exclusions and matching on 21 baseline characteristics, the primary cohort included 2684 patients: 910 receiving acoramidis and 1774 receiving tafamidis. Mean follow-up was 299 days in the acoramidis group and 312.4 days in the tafamidis group.²

The composite end point favored acoramidis in the primary matched analysis (HR, 0.82; 95% CI, 0.73-0.93; P < .01), in the unadjusted analysis (HR, 0.82; 95% CI, 0.72-0.90; P < .001), and in a sensitivity analysis adjusting for natriuretic peptide levels where available (HR, 0.84; 95% CI, 0.72-0.97; P = .02).¹ Kaplan-Meier curves for the composite separated early and stayed apart over follow-up.

Acoramidis was also associated with a lower risk of hospitalization compared with tafamidis:

• Cardiovascular hospitalization (HR, 0.73; 95% CI, 0.62-0.86)
• Heart failure hospitalization (HR, 0.73; 95% CI, 0.62-0.87)
• All-cause hospitalization (HR, 0.75; 95% CI, 0.64-0.88)

Each of these reached P < .001. Diuretic intensification, defined as parenteral loop diuretic use, starting or escalating an oral loop diuretic, or adding a thiazide-like diuretic, was 17% lower with acoramidis (HR, 0.83; 95% CI, 0.71-0.95; P < .01).

Death (HR, 0.85; 95% CI, 0.62-1.20; P = .34) and new-onset atrial fibrillation (HR, 0.88; 95% CI, 0.68-1.13; P = .31) numerically favored acoramidis but did not differ significantly. BridgeBio attributed this to low event counts and limited follow-up.

Findings Echo an Earlier Claims Study, With Caveats

Tafamidis was the only approved ATTR-CM therapy in the US from 2019 until acoramidis was approved in 2024, and no head-to-head randomized trial has compared the 2 stabilizers.³ The EHR results line up with a claims-based analysis by Wright et al published in Cardiology and Therapy, which used Komodo Healthcare Map claims data on 170 patients receiving acoramidis and a weighted sample of 448 receiving tafamidis. Over mean follow-up of 139 and 143 days, respectively, acoramidis was associated with a 43% lower hazard of diuretic intensification (HR, 0.57; 95% CI, 0.35-0.92; P = .021) and a 34% lower hazard of a composite of diuretic intensification, heart failure hospitalization, and death (HR, 0.66; 95% CI, 0.44-0.99; P = .046). Lanfear was a coauthor of that study.

Although matched characteristics were well balanced, mean B-type natriuretic peptide levels among patients with available measurements were lower in the acoramidis group than in the tafamidis group (839.5 vs 1294.0 pg/mL; P = .006), and the investigators said the results need replication.² BridgeBio noted that residual confounding cannot be ruled out and that short follow-up, a result of acoramidis' recent approval, limited the number of less frequent events such as deaths.¹

"While electronic health record studies have well-recognized limitations, these data allow us to see how these therapies perform outside of a clinical trial, across a diverse and contemporary patient population,” said Lanfear in a statement. “Moreover, there appears to be some consistency of findings across data sources and endpoints, supporting validity."

References

1. Acoramidis associated with significantly improved clinical outcomes versus tafamidis in ATTR-CM in an independent, real-world study of US electronic health records. News release. BridgeBio Pharma. October 11, 2026. Accessed November 4, 2026. https://investor.bridgebio.com/news/news-details/2026/Acoramidis-Associated-with-Significantly-Improved-Clinical-Outcomes-Versus-Tafamidis-in-ATTR-CM-in-an-Independent-Real-World-Study-of-U-S--Electronic-Health-Records/default.aspx
2. McCurdy B. Real-world ATTR-CM study suggests superior clinical outcomes in patients receiving acoramidis compared to tafamidis. Consultant360. October 13, 2026. Accessed November 4, 2026. https://www.consultant360.com/conference-coverage/real-world-attr-cm-study-suggests-superior-clinical-outcomes-patients-receiving
3. Wright R, Martyn T, Keshishian A, et al. Comparative effectiveness of TTR stabilizers for the Treatment of ATTR-CM using real-world evidence. Cardiol Ther. Published online September 23, 2026. doi:10.1007/s40119-026-00476-2