Patisiran is a novel agent that has been approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) for treating polyneuropathy in adults caused by hereditary transthyretin (TTR) amyloidosis.  It is one of a new class of drugs called small interfering ribonucleic acid (siRNA) treatments, which work by silencing specific genes. Patisiran inhibits the production of TTR in the liver. It is the second of its class to be approved in Europe for this indication (inotersen was approved by the EMA in July 2018). It is the first therapeutic of its class to be approved in the US.
Approval was based on the results of an 18-month randomised placebo-controlled phase III trial (APOLLO). In the trial, patisiran reduced neurological impairment and improved quality of life compared with placebo in patients with TTR amyloidosis with polyneuropathy. The incidence and severity of adverse events were similar in patients receiving patisiran and placebo.
TTR amyloidosis is the most common form of inherited amyloidosis. It is a progressively debilitating disease that can lead to death. Liver transplantation is considered standard of care for these patients; however, this is limited to those who are fit enough for transplantation and who have a suitable donor. Patisiran provides clinicians with an alternative treatment option to liver transplantation in patients with TTR amyloidosis.See Management: approach See Management: treatment algorithm
An amyloid tissue deposition disease that may have a primary cause or be secondary to other diseases.
Usually presents with unexplained weight loss, fatigue, and oedema resistant to diuretic therapy.
Immunofixation of the serum and urine confirms the presence of monoclonal light chains in primary systemic amyloidosis. Biopsy verification of amyloid deposits is essential.
Treatment includes appropriate management of resulting clinical syndromes, such as nephrotic syndrome, neuropathy, cardiomyopathy, and conduction disorders.
Definitive treatment of primary systemic amyloidosis (AL amyloidosis) includes myeloablative high-dose chemotherapy, with stem cell reconstitution in selected patients, or chemotherapy.
Any histological tissue specimen that binds the cotton wool dye, Congo red, and demonstrates green birefringence when viewed under polarised light is, by definition, an amyloid deposit. The patient with this deposit has amyloidosis. Deposits of amyloid may be localised in tissue or part of a systemic process. Progressive deposition of amyloid is disruptive to tissue and organ function and manifests its clinical sequelae by the dysfunction of those organs in which it deposits.  
Seidler Jr. Professor of Medicine
Consultant in Hematology
Chair Emeritus of the Department of Medicine
Mayo Distinguished Clinician
Mayo Clinic College of Medicine
MAG declares that he has received honoraria from Celgene Corporation, Prothena Corporation Plc, Onyx Pharmaceuticals, Alnylam, and Ionis Pharmaceuticals. MAG is also an author of several references cited in this monograph.
Associate Professor of Medicine
Program for Multiple Myeloma and Related Diseases
Princess Margaret Hospital
DR has been reimbursed by Millennium Pharmaceuticals, Inc and Johnson and Johnson, the manufacturers of bortezomib, for attending several conferences, for speaking at educational meetings, and for consulting work. She has also been reimbursed by Celgene, the manufacturer of lenalidomide and thalidomide, for attending several symposia and serving as a speaker.
Assistant Professor of Medicine and Oncology
Division of Hematology/Oncology
Wayne State University School of Medicine
Barbara Ann Karmanos Cancer Institute
JZ declares that he has no competing interests.
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