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Three disease-modifying agents are now approved for treatment in Germany: the transthyretin (TTR) stabilizers tafamidis and acoramidis, and the TTR gene silencer vutrisiran. In the absence of head-to-head trials, practical guidance for individual treatment decisions is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multidisciplinary expert panel appointed by the German Society of Amyloid Diseases (DGAK) and the German Cardiac Society (DGK) performed a comprehensive review of pivotal randomized controlled trials, open-label extension studies, real-world data, and the approved German summaries of product characteristics to develop evidence-based consensus recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All three agents have demonstrated significant reductions in all-cause mortality and cardiovascular hospitalizations in phase 3 trials with comparable efficacy and tolerability profiles. Due to the absence of direct comparative studies, the panel concludes that tafamidis, acoramidis, and vutrisiran, based on the current scientific data, are considered similarly effective for most patients with confirmed ATTR-CM. An exception applies to patients with hereditary ATTR-CM and a mixed phenotype (concurrent cardiomyopathy and polyneuropathy), for whom vutrisiran is recommended as first-line therapy. Combination therapy is safe but, lacking randomized data regarding efficacy, cannot be recommended at present. Treatment decisions should incorporate patient preferences, comorbidities, mode of administration, and local regulatory frameworks. Regular monitoring using clinical parameters, biomarkers including TTR serum levels, and cardiac imaging is recommended.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This consensus provides a practical framework for the specific treatment of ATTR-CM in Germany, aiming for early treatment initiation. Local standards and shared decision-making remain essential for the establishment of ATTR-CM therapy in an individual patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-03006-1","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:06:25Z","timestamp":1790067985000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Specific treatment of ATTR-CM in Germany\u2014expert consensus of the German Society of Amyloid Diseases (DGAK) and German Cardiac Society (DGK)"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4264-1722","authenticated-orcid":false,"given":"Fabian","family":"aus dem Siepen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Trenkwalder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"A\u00dfmus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Kindermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lavall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Spethmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Michel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timon","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kruck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Rischpler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Knebel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie K.","family":"Schwarting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udo","family":"Bavendiek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Papathanasiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Hegenbart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Yilmaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Carpinteiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Pfister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Morbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"issue":"11","key":"3006_CR1","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1056\/NEJMoa1805689","volume":"379","author":"MS Maurer","year":"2018","unstructured":"Maurer MS, Schwartz JH, Gundapaneni B et al (2018) Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. 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Further research grants from Pfizer and Bayer.Birgit A\u00dfmus reports personal fees for lectures and advice from Abbott, Alnylam, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Edwards, Novartis, NovoNordisk, Lilly, Pfizer, Vifor CSL, ZOLL CMS within the last 12\u00a0months, outside the submitted work.Ingrid Kindermann reports consulting fees, advisory, and speakers honoraria as well as travel grants from Pharmacosmos GmbH, Pfizer Pharma GmbH, Bristol- Myers-Squibb, Daiichi Sankyo, Akcea Therapeutics Germany GmbH, Vifor Pharma Deutschland, Novartis Pharma GmbH, Servier Deutschland GmbH, AstraZeneca GmbH, Bayer Vital GmbH, Alnylam, SOBI, Diaplan, Boehringer- Ingelheim Pharma GmbH &Co.KG, Orionpharma, Scirac. She serves as principal investigator in trials sponsored by IONIS Pharmaceuticals, Alexion Pharmaceuticals, and AstraZeneca.Daniel Lavall received speaker and\/or consulting fees from Pfizer, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Alnylam, and AstraZeneca; researchg grant from Pfizer.S. Spethmann reports scientific grants from Innovation Committee at the Federal Joint Committee (G-BA), Pfizer Pharma GmbH, and Apple Inc.; Honoraria for lectures from Novartis Pharma GmbH, AstraZeneca GmbH, Pfizer Pharma GmbH, Alnylam Netherlands B.V., Boehringer Ingelheim Pharma GmbH, Medtronic GmbH, and Bayer Vital GmbH; travel fees from Pfizer Pharma GmbH, Alnylam Netherlands B.V., AstraZeneca GmbH, Medtronic GmbH, and Boehringer Ingelheim Pharma GmbH; Advisory fees from Boehringer Ingelheim Pharma GmbH, Novartis Pharma GmbH, Pfizer Pharma GmbH, Alnylam Netherlands B.V., and Bayer Vital GmbH.Lars Michel has received personal fees outside the submitted work from Alnylam, AstraZeneca, Bayer, Bristol Myers Squibb, IFFM e.V., Pfizer, and Bund der Niedergelassenen Kardiologen (BNK); he has received research funding from Deutsche Forschungsgemeinschaft (DFG, 569508066), Else-Kroener-Fresenius-Foundation, University Medicine Foundation, University Hospital Essen, and from Bayer for an investigator\/institution-sponsored collaborative study, all outside the submitted work.Timon Hansen received consulting and\/or lecture fees from Pfizer, Bayer, Alexion, Alnylam and AstraZeneca.Sebastian Kruck received speaker and\/or consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Novartis, Pfizer, Sanofi and Vifor.Christoph Rischpler received speaker honoraria from Alnylam, Bayer, Curium, GE Healthcare, Novartis, Pfizer, Rotop, Siemens Healthineers and consulting fees from Novartis and Pfizer, all outside of the submitted work.Fabian Knebel received speaker and\/or consulting fees from Amicus, Amgen, Pfizer, Alnylam, AstraZeneca, Bayer, Boehringer Ingelheim, GE, Sanofi, Takeda, BMS, Canon, TomTec, Bracco, Novartis, Cytokinetics, Lilly, Zoll, Sanofi.St\u00e9phanie K. Schwarting received speaker and\/or consultant fees from Alnylam, Bayer Vital, Alexion, Pfizer, and serves as a principal investigator for clinical studies sponsored by Alnylam, Alexion, Bayer, AstraZeneca, NovoNordisk, and Intellia Pharmaceuticals. Research Grant by Bayer.Udo Bavendiek received travel support and honoraria for lectures\/consulting from Alnylam Pharmaceutical, Amgen, Astra Zeneca, Bayer Vital, Boehringer Ingelheim, Bristol Myers Squibb, Lilly, Novartis, NovoNordisk, and Pfizer and institutional research support from Alnylam Pharmaceuticals.Maria Papathanasiou received speaker and consultant fees from Alnylam, AstraZeneca, Bayer Vital, Alexion, Pfizer, Bristol Myers Squibb, Cytokinetics, Janssen, NovoNordisk, research grant from Alnylam and serves as a primary investigator for clinical studies sponsored by AstraZeneca, NovoNordisk, Cytokinetics, AMGEN.Ute Hegenbart received Honorarium for talks from Janssen, Pfizer, Alnylam, Prothena, Astra Zeneca, financial support of congress participation from Janssen, Prothena, Pfizer, consultant fees from Pfizer, Prothena, Janssen, Alexion, Alnylam, Neurimmune, Astra Zeneca and financial sponsoring of the Amyloidosis Registry from Janssen, Alexion, Prothena.Ali Yilmaz performed consultant activities for Alnylam, AstraZeneca, Bayer, Alexion, Pfizer, Bristol Myers Squibb, Cytokinetics, NovoNordisk and GE Healthcare; he has research collaborations with Philips and Circle Cardiovascular Imaging.Katrin Hahn received financial reimbursement for consulting, advisory board activities, speaker fees and\/or contributions to congresses and travel support to attend scientific meetings by Akcea Therapeuticals Inc., Alnylam Pharmaceuticals Inc., Amicus, AstraZeneca, Bayer Vital GmbH, BridgeBio, GSK, Hormosan, Takeda Pharmaceutical Inc., Pfizer Pharmaceuticals Inc., Purpose Pharma, Swedish Orphan Biovitrum Inc and ViiV Healthcare GmbH. KH further received research funding by the foundation Charit\u00e9 (BIH clinical fellow and digital accelerator), Alnylam Pharmaceuticals Inc., Amicus, AstraZeneca, Hormosan and Pfizer Pharmaceuticals.Alexander Carpinteiro received consulting and\/or lecture fees from Alexion, Alnylam, Amgen, GSK, Johnson&Johnson, Pfizer, Sanofi and Takeda and travel and congress participation grants from Johnson&Johnson.Roman Pfister received speaker and consultant fees by Alnylam, AstraZeneca, Bayer and Pfizer, Research Grant by Alnylam, Bayer and Pfizer.Caroline Morbach received advisory honoraria, speakers honoraria, and travel grants from Alexion, Alnylam, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Edwards, Eli Lilly, Intellia, Janssen, NovoNordisk, and Pfizer; she serves as principal investigator in trials sponsored by Alnylam, AstraZeneca, Bayer, Intellia, and NovoNordisk\u00a0as well as in the steering committee of a trial sponsored by Alnylam.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}