Assessment of patients with hereditary transthyretin amyloidosis - understanding the impact of management and disease progression

Amyloid. 2019 Sep;26(3):103-111. doi: 10.1080/13506129.2019.1627312. Epub 2019 Jul 24.

Abstract

Timely diagnosis of hereditary variant transthyretin (ATTRv) amyloidosis is critical for appropriate treatment and optimal outcomes. Significant differences are seen between patients receiving treatment and those who are not, though disease progression may continue despite treatment in some patients. Healthcare professionals caring for patients with ATTRv amyloidosis therefore need reliable ongoing assessments to understand the continuing course of disease and make appropriate treatment choices on an individual basis. Various signs and symptoms experienced by patients may be evaluated as indicators of disease progression, though there is currently no validated score that can be used for such ongoing assessment. Recognizing this situation, a group of clinicians highly experienced in ATTR amyloidosis developed an approach to understand and define disease progression in diagnosed and treated patients with ATTRv amyloidosis. The suggested approach is based on the recognition of distinct phenotypes which may usefully inform the particular tools, tests and investigations that are most likely to be appropriate for individual patients. It is aimed at implementing appropriate and ongoing assessment of patients being treated for ATTRv amyloidosis, such that the effectiveness of management can be usefully assessed throughout the course of disease and management can be tailored according to the patient's requirements.

Keywords: ATTR; amyloidosis; follow-up; hereditary; monitoring; progression; transthyretin.

Publication types

  • Review

MeSH terms

  • Adult
  • Age of Onset
  • Aged
  • Amyloid Neuropathies, Familial / diagnosis*
  • Amyloid Neuropathies, Familial / drug therapy
  • Amyloid Neuropathies, Familial / genetics
  • Amyloid Neuropathies, Familial / physiopathology
  • Cardiomyopathies / diagnosis*
  • Cardiomyopathies / drug therapy
  • Cardiomyopathies / genetics
  • Cardiomyopathies / physiopathology
  • Consensus
  • Disease Management*
  • Disease Progression
  • Female
  • Glaucoma / diagnosis*
  • Glaucoma / drug therapy
  • Glaucoma / genetics
  • Glaucoma / physiopathology
  • Heart Function Tests
  • Hereditary Sensory and Autonomic Neuropathies / diagnosis*
  • Hereditary Sensory and Autonomic Neuropathies / drug therapy
  • Hereditary Sensory and Autonomic Neuropathies / genetics
  • Hereditary Sensory and Autonomic Neuropathies / physiopathology
  • Humans
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Mutation
  • Neuroprotective Agents / therapeutic use
  • Prealbumin / deficiency
  • Prealbumin / genetics

Substances

  • Neuroprotective Agents
  • Prealbumin
  • TTR protein, human

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related