Attruby (acoramidis)

Attruby (acoramidis) is approved for adults with transthyretin amyloid cardiomyopathy, usually shortened to ATTR-CM.

The disease: ATTR-CM is a condition in which a blood protein called transthyretin (TTR) misfolds and builds up as stiff deposits in the heart muscle.

Forms covered: It covers both the wild-type form, which develops with age without a gene change, and the variant (hereditary) form caused by an inherited TTR mutation.

Treatment goal: The approved goal is to reduce deaths from heart causes and hospital stays for heart problems.

Children: It has not been studied in children.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Attruby is the brand name for acoramidis, a twice-daily tablet in a class called transthyretin stabilizers.

Maker: It is made by BridgeBio Pharma, which developed it under the code AG10 after it was first designed by researchers at Stanford University and Eidos Therapeutics.

Approval: The FDA approved it on November 22, 2024, making it the second TTR stabilizer available in the U.S. for ATTR cardiomyopathy after tafamidis.

Other names: Outside the U.S. it is sold under the name Beyonttra.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Acoramidis holds the transthyretin protein in its normal shape so it comes apart far more slowly.

Normal TTR: Transthyretin normally travels in the blood as a 4-part structure called a tetramer.

What goes wrong: In ATTR amyloidosis, that tetramer falls apart into single pieces (monomers), which then misfold and clump into amyloid deposits; the label calls this splitting the rate-limiting step in forming amyloid.

How the drug binds: Acoramidis binds TTR at the 2 pockets where the thyroid hormone thyroxine normally attaches and holds the tetramer together so it comes apart far more slowly.

In patients: This showed up as higher blood levels of intact TTR and near-complete stabilization of the protein in lab tests by day 28 of treatment, lasting through the 30-month study.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Side effects were generally mild.

Common side effects: In the 30-month trial of 421 people on Attruby, the ones that happened more often than on placebo were diarrhea (11.6% vs 7.6%) and pain in the upper belly (5.5% vs 1.4%); most of these were mild and went away without stopping the drug.

Stopping for side effects: About the same share of people quit the study drug because of a side effect in each group, 9.3% on Attruby and 8.5% on placebo.

Warnings: Attruby has no boxed warning and no contraindications, meaning the label lists no condition in which it must never be used.

Kidney labs: It also causes a small, reversible rise in the kidney lab value creatinine, described below.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Starting Attruby causes a small rise in serum creatinine and a drop in eGFR, which are lab measures of kidney filtering.

Trial numbers: In the trial, creatinine went up by an average of 0.2 mg/dL and eGFR fell by about 8.2 points at day 28, compared with no creatinine change and a 0.7-point eGFR drop on placebo.

Timing: The change usually happens within the first 4 weeks, then levels off, and it reversed when people stopped the drug.

What it means: The label does not interpret this as kidney damage, and it says the drug's levels in the body are not significantly different in people with reduced kidney function, so no dose change is listed for them.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

In the ATTRibute-CM trial, fewer people on Attruby died or were hospitalized for heart problems than on placebo.

Trial design: The trial enrolled 611 adults with wild-type or variant ATTR cardiomyopathy, average age 77 and 91% male, and gave them Attruby or placebo twice daily for 30 months.

Deaths and hospitalizations: Over that time, 19% of Attruby patients died versus 26% on placebo, and 27% had a heart-related hospitalization versus 43%; heart failure hospitalizations specifically were 13% versus 26%. A combined analysis showed a 35.5% lower risk of death or first heart hospitalization.

Walking and quality of life: Attruby patients also walked 40 meters farther on a 6-minute walk test and scored 10 points better on a heart failure quality-of-life questionnaire than placebo patients at 30 months.

Tafamidis add-on: Patients were allowed to add tafamidis after 12 months, which 14.9% of the Attruby group and 22.8% of the placebo group did.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

The dose is 712 mg twice a day, taken as 2 tablets of 356 mg each morning and evening, with or without food.

How to take: Swallow the tablets whole; do not cut, crush, or chew them.

Storage: Keep them in the original blister card at room temperature (68 to 77 degrees F) until you take them, because they need protection from moisture.

Packaging: The tablets come in a 112-count carton of blister cards or a 120-count bottle.

Older adults: No dose adjustment is listed for people 65 and older.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Acoramidis is cleared by liver enzymes called UGTs rather than the common CYP3A pathway.

Avoid: Drugs that rev up UGT enzymes, and strong CYP3A inducers such as rifampin, which also boost UGT, can lower acoramidis levels, so the label says to avoid combining them.

CYP2C9 drugs: Acoramidis also blocks the enzyme CYP2C9, which can raise blood levels of medicines that depend on that enzyme to be cleared, so your doctor may monitor you more closely if you take one of those.

Diuretics: Diuretics (water pills), which many heart patients use, do not change acoramidis levels.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

No, there is no generic acoramidis.

What is available: Attruby was approved in November 2024, and the only version available is the brand-name 356 mg tablet from BridgeBio Pharma.

What to do: If a pharmacy offers you something described as generic Attruby, ask the pharmacist to confirm exactly what it is.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

The FDA label does not list a price, and we do not publish one because what you pay depends on your insurance plan, deductible, and pharmacy.

What to expect: Attruby is a specialty medicine for a rare disease, so expect a high list price, a specialty pharmacy, and prior authorization.

Assistance: Our entry for acoramidis does not list a named manufacturer support program, so ask BridgeBio Pharma directly or have your cardiologist's office check what copay or free-drug help is available for your situation.

Both are oral TTR stabilizers, but they differ in how tightly they bind TTR and how often they are taken.

Stabilization: Acoramidis achieves near-complete stabilization of TTR (over 90% in lab tests) compared with the partial stabilization seen with tafamidis, because it binds more tightly using multiple contact points.

Dosing schedule: Attruby is taken twice a day since it clears the body in about 6 hours, while tafamidis is taken once a day because its half-life is about 49 hours.

Head-to-head data: The 2 drugs have never been compared in a head-to-head trial, so it is not known whether the higher stabilization translates into better outcomes.

Trial crossover: In ATTRibute-CM, patients could add tafamidis after 12 months, and fewer Attruby patients did so (14.9%) than placebo patients (22.8%).

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Think of Attruby as a long-term treatment to slow the disease rather than something that relieves symptoms quickly.

Lab signs: Blood levels of acoramidis reach a steady state within 4 days, and the label reports higher blood levels of intact TTR plus near-complete stabilization by day 28. Those are lab signs that the drug is doing its job, not symptoms you would feel.

Outcomes: The benefits that matter, fewer deaths and hospitalizations, were measured over 30 months, and the differences in walking distance and quality of life were reported at the 30-month mark.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Yes, Attruby can lower the amount of free thyroxine (free T4) measured in the blood without changing TSH, the pituitary hormone that normally signals a real thyroid problem.

Why: The label explains this is probably because TTR carries thyroxine in the blood and the drug changes how thyroxine binds to it, a pattern seen with TTR stabilizers as a class.

What to do: If your thyroid labs look off while you are on Attruby, make sure the doctor reading them knows you take it.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Attruby is approved in the U.S. only for the heart form of ATTR amyloidosis (cardiomyopathy).

Nerve form: It has not been specifically studied or approved for ATTR polyneuropathy, the form that damages nerves.

In theory: Because it stabilizes both wild-type and mutant TTR, it could in theory slow amyloid buildup in nerves too, but that has not been tested.

What to do: People with polyneuropathy should discuss all options with their neurologist, including gene silencing therapies.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

TTR stabilization describes how well a drug keeps the transthyretin protein locked in its normal 4-part shape.

Why it matters: When TTR comes apart, the loose pieces misfold and form amyloid deposits in the heart and nerves.

Acoramidis numbers: Acoramidis stabilizes more than 90% of circulating TTR in lab tests, so very little of the protein is free to misfold, and the label reports this near-complete effect as early as day 28 and throughout the 30-month trial.

Versus tafamidis: This is a higher level than seen with tafamidis in lab testing, though whether that difference changes patient outcomes has not been tested.

Source: FDA label for Attruby, DailyMed, effective 2026-06-29

Acoramidis was designed at Stanford University to copy the effect of a naturally protective gene variant called T119M.

The T119M variant: It is found in some people who carry a TTR mutation but never develop amyloidosis because their TTR tetramer is unusually sturdy.

Development: Researchers at Eidos Therapeutics, later acquired by BridgeBio Pharma, engineered a small molecule that binds TTR in a way that mimics that extra stability.

Result: The result is a drug that makes the protein highly resistant to falling apart, which is the first step in forming amyloid.