Familial amyloidosis medical therapy
|
Familial amyloidosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Familial amyloidosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Familial amyloidosis medical therapy |
|
Risk calculators and risk factors for Familial amyloidosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]
Overview
Medical Therapy
- The optimal therapy for familial amyloidosis is removal of the source of abnormal TTR production.
- The liver is the dominant source of transthyretin; hence, in patients with less advanced disease, liver transplant may be performed.
- Patients with severe heart involvement may benefit from a heart transplant.
- The need for better therapies has resulted in the development of a number of novel strategies, and some of these have been assessed in clinical trials. These therapies may slow or halt progression of familial ATTR amyloidosis.
- Tafamidis
- 2-(3,5–dichloro–phenyl)-benzox-azole-6-carboxylic acid is an orally administered drug that acts to stabilize the TTR tetramer through its affinity for the T4-binding site, and it does not carry the risks associated with nonsteroidal anti-inflammatory drug use.
- A drug recently approved for familial amyloid polyneuropathy (FAP) in Europe.[1]
- This agent is being tested in ongoing trials for other forms of ATTR.
- Patisiran and Inoteresen are TTR gene silencers. Recently FDA approved their use for ATTRm amyloidosis with peripheral neuropathy.[2]
- Diflunisal is a nonsteroidal anti-inflammatory drug that stabilizes tetrameric TTR in vitro by binding via the thyroid hormone receptor sites
- Tafamidis
- Genetic counseling is recommended for individuals with hereditary amyloidosis and their family members.
References
- ↑ Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M; et al. (2018). "Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy". N Engl J Med. 379 (11): 1007–1016. doi:10.1056/NEJMoa1805689. PMID 30145929.
- ↑ Benson MD, Waddington-Cruz M, Berk JL, Polydefkis M, Dyck PJ, Wang AK; et al. (2018). "Inotersen Treatment for Patients with Hereditary Transthyretin Amyloidosis". N Engl J Med. 379 (1): 22–31. doi:10.1056/NEJMoa1716793. PMID 29972757.