ATTR-CM market shifts from one drug to three

The US market for transthyretin amyloid cardiomyopathy (ATTR-CM), a progressive heart disease, has changed sharply in under two years. For most of the period since 2019, Pfizer's tafamidis was the only approved option; the FDA described its 2019 approval as the first for the condition. BridgeBio's Attruby, an oral stabilizer, won approval in November 2024. Alnylam's Amvuttra, an RNA-interference silencer given by injection, followed in March 2025.

Pfizer's Vyndamax still accounts for about 75% of prescriptions, according to figures cited in its April settlement announcement. But BridgeBio says Attruby is now the fastest-growing brand in the category, and its first-line share is rising.

The American College of Cardiology's 2025 guidance covers all three drugs and says no study has shown one to be superior to another. It also found the data insufficient to recommend routine combination therapy.

Analysts say the next phase of competition will turn less on whether the drugs work and more on what each adds for patients already in treatment.