Acoramidis beats tafamidis on cardiac outcomes in real-world EHR study

A propensity-matched analysis of nearly 2,700 ATTR-CM patients found acoramidis cut composite cardiovascular risk by 18% versus tafamidis.

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BridgeBio Pharma has presented independent real-world evidence suggesting its transthyretin stabiliser acoramidis outperforms rival tafamidis on a range of cardiovascular outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). The data, drawn from the Epic COSMOS electronic health record database, were shared at the Heart Failure Society of America Annual Scientific Meeting in Phoenix on 11 October 2026.

The retrospective, propensity score-matched analysis was conducted and presented by David Lanfear of Henry Ford Health. After matching, the dataset included 910 patients initiating acoramidis and 1,774 initiating tafamidis. The composite primary endpoint, covering death, all-cause hospitalisation, new-onset atrial fibrillation, and diuretic intensification, was 18% lower in the acoramidis group (HR 0.82; 95% CI 0.73–0.93; p less than 0.01). Kaplan-Meier curves began to separate within one month of treatment initiation.

Hospitalisation data lead the findings

The most clinically striking results relate to hospitalisation, which is widely regarded as a central management target in ATTR-CM. Acoramidis was associated with a 27% lower risk of cardiovascular hospitalisation (HR 0.73; p less than 0.001), a 27% lower risk of heart failure hospitalisation (HR 0.73; p less than 0.001), and a 25% lower risk of all-cause hospitalisation (HR 0.75; p less than 0.001). Diuretic intensification, an early marker of disease progression, was 17% lower with acoramidis (HR 0.83; p less than 0.01). Differences in mortality and new-onset atrial fibrillation numerically favoured acoramidis but did not reach statistical significance, which the investigators attributed to limited follow-up given the relatively recent approval of acoramidis.

These results replicate an earlier claims-based analysis published in Cardiology and Therapy, in which acoramidis was associated with a 34% reduction in clinical worsening events versus tafamidis. BridgeBio is positioning the consistency across two independent datasets and two data types as evidence of reproducibility, though both studies remain observational. The Epic COSMOS analysis is currently under peer review.

Lanfear acknowledged the inherent limitations of retrospective EHR studies, including the possibility of residual confounding despite propensity matching, and called for additional investigations with longer follow-up.

Competitive and regulatory context

The ATTR-CM stabiliser market is currently a two-horse race. Tafamidis, marketed by Pfizer as Vyndamax and Vyndaqel, was the first approved oral TTR stabiliser and has built a substantial installed patient base since its 2019 US approval. Acoramidis, approved by the FDA as Attruby in late 2024, positions itself as a near-complete stabiliser achieving greater than 90% TTR stabilisation, compared with the roughly 60% stabilisation reported for tafamidis at standard doses. That mechanistic distinction has underpinned BridgeBio's commercial narrative, and this EHR dataset provides the first electronic health record evidence supporting a clinical correlate.

Alongside the EHR study, BridgeBio shared a post hoc analysis from its ATTRibute-CM Phase 3 trial showing that mortality risk approximately doubled after a single cardiovascular hospitalisation and quadrupled after two or more, reinforcing hospitalisation prevention as a meaningful surrogate for survival. A separate sub-analysis of the 35 p.Val142Ile variant patients in ATTRibute-CM reported significant preservation of health status and quality of life with acoramidis, with differences in KCCQ-OS scores of 23.3 points versus placebo (p equals 0.005), well above published thresholds for clinically meaningful change.

For prescribers, the accumulating dataset is likely to sharpen conversations around both de novo treatment selection and switching in patients showing signs of progression on tafamidis. BridgeBio said further analyses with longer follow-up are planned for future medical meetings, and the ongoing ASCEND-ATTR imaging study aims to determine whether sustained TTR stabilisation translates into measurable cardiac remodelling.

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