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2015 ; 22
(3
): 175-80
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Personalized medicine approach for optimizing the dose of tafamidis to
potentially ameliorate wild-type transthyretin amyloidosis (cardiomyopathy)
#MMPMID26193961
Cho Y
; Baranczak A
; Helmke S
; Teruya S
; Horn EM
; Maurer MS
; Kelly JW
Amyloid
2015[]; 22
(3
): 175-80
PMID26193961
show ga
Placebo-controlled clinical trials are useful for identifying the dose of a drug
candidate that produces a meaningful clinical response in a patient population.
Currently, Pfizer, Inc. is enrolling a 400-person clinical trial to test the
efficacy of 20 or 80?mg of tafamidis to ameliorate transthyretin (TTR)-associated
cardiomyopathy using clinical endpoints. Herein, we provide guidance for how to
optimize the dose of tafamidis for each WT TTR cardiomyopathy patient using its
mechanism of action as the key readout, i.e. we identify the dose of tafamidis
that maximally kinetically stabilizes TTR in the blood. Tetramer dissociation is
rate limiting for TTR aggregation, which appears to drive the pathology of the
TTR amyloidoses. Hence, we measure the TTR tetramer dissociation rate (kinetic
stability) in the patient's plasma as a function of tafamidis dose to optimize
the dose employed to maximize kinetic stability. Historical data tell us that a
subset of patients exhibiting higher tafamidis plasma concentrations are
maximally kinetically stabilized at the 20-mg tafamidis dose, whereas the patient
studied herein required a 60?mg once daily dose to achieve maximum kinetic
stabilization. We anticipate that establishing the dose of tafamidis that
achieves maximal TTR kinetic stabilization will translate into a maximal clinical
effect, but that remains to be demonstrated.