{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:32:21Z","timestamp":1772253141630,"version":"3.50.1"},"reference-count":29,"publisher":"Sociedade Brasileira de Cardiologia","issue":"8","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo  Fundamento: A cardiomiopatia por amiloidose por transtirretina (ATTR-CM) \u00e9 a forma mais comum de cardiomiopatia restritiva. Novas terapias farmacol\u00f3gicas buscam modificar a progress\u00e3o natural da doen\u00e7a e retardar seu avan\u00e7o. No entanto, ainda s\u00e3o escassos os dados que comparam diretamente a efic\u00e1cia das diferentes classes de f\u00e1rmacos em rela\u00e7\u00e3o ao placebo.  Objetivos: Esta revis\u00e3o sistem\u00e1tica e metan\u00e1lise avaliou a efic\u00e1cia dos estabilizadores e silenciadores de transtirretina (TTR), em compara\u00e7\u00e3o ao placebo, sobre a mortalidade e hospitaliza\u00e7\u00f5es por todas as causas, desfechos funcionais e n\u00edveis do biomarcador NT-proBNP em pacientes com ATTR-CM.  M\u00e9todos: Foram realizadas buscas nas bases de dados PubMed, Embase e Cochrane por ensaios cl\u00ednicos randomizados (ECRs) publicados at\u00e9 abril de 2025, que avaliaram patisiran, tafamidis, inotersen, revusiran, acoramidis ou vutrisiran versus placebo em pacientes com ATTR-CM. As an\u00e1lises foram estratificadas por classe de f\u00e1rmaco, considerando signific\u00e2ncia estat\u00edstica para p&lt;0,05.  Resultados: Foram inclu\u00eddos sete ECRs, totalizando 2.526 participantes; 42,5% receberam estabilizadores de TTR e 57,5% receberam silenciadores de TTR. Em compara\u00e7\u00e3o ao placebo, os estabilizadores de TTR reduziram significativamente a mortalidade (RR: 0,71; IC 95% 0,59-0,87; p=0,0006) e e hospitaliza\u00e7\u00f5es (RR: 0,81; IC 95% 0,73-0,89; p&lt;0,0001), ambas por todas as causas. J\u00e1 os silenciadores de TTR n\u00e3o reduziram significativamente nem a mortalidade (RR: 0,79; IC 95% 0,37-1,68; p=0,54) nem as hospitaliza\u00e7\u00f5es (RR: 1,11; IC 95% 0,83-1,48; p=0,48). As duas abordagens terap\u00eauticas melhoraram a dist\u00e2ncia percorrida no teste de caminhada de 6 minutos, a qualidade de vida e reduziram os n\u00edveis s\u00e9ricos NT-proBNP.  Conclus\u00e3o: Os estabilizadores de TTR reduziram significativamente a mortalidade e as hospitaliza\u00e7\u00f5es por todas as causas em pacientes com ATTR-CM, em compara\u00e7\u00e3o ao placebo. Esses benef\u00edcios n\u00e3o foram observados com os silenciadores de TTR, possivelmente em fun\u00e7\u00e3o do tempo de seguimento mais curto nos estudos inclu\u00eddos. Ambas as terapias, contudo, promoveram melhorias no estado funcional e na redu\u00e7\u00e3o dos n\u00edveis s\u00e9ricos do biomarcador NT-proBNP.<\/jats:p>","DOI":"10.36660\/abc.20240830","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:00:57Z","timestamp":1760461257000},"source":"Crossref","is-referenced-by-count":0,"title":["Terapias Modificadoras de Doen\u00e7a para a Cardiomiopatia por Amiloidose por Transtirretina: Uma Revis\u00e3o Sistem\u00e1tica e Metan\u00e1lise"],"prefix":"10.36660","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6060-8403","authenticated-orcid":false,"given":"Ligia Carolina","family":"Facin","sequence":"first","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor Pacheco Fiuza","family":"Romeiro","sequence":"additional","affiliation":[{"name":"Universidade Federal do Cear\u00e1,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaushiki","family":"Sapahia","sequence":"additional","affiliation":[{"name":"University College of Medical Sciences of New Delhi,  \u00cdndia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz Austreg\u00e9silo de Athayde de Hollanda","family":"Morais","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio de Macei\u00f3,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Queiroz Vasconcelos","family":"Muniz","sequence":"additional","affiliation":[{"name":"Schmieder Klinik Heidelberg,  Alemanha"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Domenes","family":"Pereira","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Campinas,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cintia","family":"Gomes","sequence":"additional","affiliation":[{"name":"University of Colorado Health Parkview Medical Center,  EUA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celina Borges","family":"Migliavaca","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Zimerman","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Universidade Federal do Rio Grande do Sul,  Brasil; Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8579-4158","authenticated-orcid":false,"given":"Andreia","family":"Biolo","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Universidade Federal do Rio Grande do Sul,  Brasil; Hospital de Cl\u00ednicas de Porto Alegre,  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