Successful transition to Vutrisiran therapy for a patient with ATTR-FAP after severe infusion reaction to Patisiran

Abstract

　A 56-year-old male patient presented with peripheral neuropathy since his late 40s and was diagnosed with hereditary transthyretin ( ATTRv ) amyloidosis with a Val30Met mutation. After the diagnosis, the patient received patisiran but discontinued due to an infusion reaction with swelling at the injection site and fever. Subsequently, the patient was treated with tafamidis. At the age of 56, the patient was admitted to our hospital for worsening autonomic symptoms, and after obtaining informed consent, the treatment was switched to vutrisiran. Administration under careful monitoring was successfully completed without any adverse reactions. Considering that the patient had experienced adverse reactions to COVID-19 mRNA vaccines, it is suggested that additives such as PEG were a cause of the infusion reaction. ATTRv amyloidosis is a fatal disease, and nucleic acid therapeutics that improve prognosis should not be abandoned solely because of previous adverse effects. Vutrisiran may be a viable treatment option even for patients who have experienced adverse reactions to patisiran.