Navigating Therapeutic Pathways and Transforming Care in ATTR-CM - Episode 12
Approaches to Treatment Selection in ATTR-CM
The panel discusses how clinicians approach selecting disease-modifying therapy once ATTR-CM is confirmed. They emphasize that treatment choice is individualized and begins with assessing disease stage and overall cardiac function. If a patient is extremely advanced and unlikely to benefit, the conversation may shift toward goals of care. For most patients, the next consideration is whether neuropathy is present, particularly in hereditary variants, where a silencer such as vutrisiran may be preferred because it addresses both cardiac and neurologic manifestations. Cost and access are also significant factors, and the panel notes that insurance coverage may determine which agent is feasible. Finally, patient preference plays an important role: some prefer a daily oral therapy, while others favor a less frequent injection to avoid managing multiple medications. The experts emphasize shared decision-making, stating that the key principle is to initiate approved therapy, as the only clearly wrong choice is receiving no treatment.
The panel discusses how clinicians approach selecting disease-modifying therapy once ATTR-CM is confirmed. They emphasize that treatment choice is individualized and begins with assessing disease stage and overall cardiac function. If a patient is extremely advanced and unlikely to benefit, the conversation may shift toward goals of care. For most patients, the next consideration is whether neuropathy is present, particularly in hereditary variants, where a silencer such as vutrisiran may be preferred because it addresses both cardiac and neurologic manifestations.
Cost and access are also significant factors, and the panel notes that insurance coverage may determine which agent is feasible. Finally, patient preference plays an important role: some prefer a daily oral therapy, while others favor a less frequent injection to avoid managing multiple medications. The experts emphasize shared decision-making, stating that the key principle is to initiate approved therapy, as the only clearly wrong choice is receiving no treatment.
