Camblor Blasco, AndreaDevesa, AnaNieto Roca, LuisGómez-Talavera, SandraLumpuy-Castillo, JairoPello Lázaro, Ana MaríaLlanos Jiménez, LucíaSánchez González, JavierLorenzo, ÓscarTuñón, JoseIbáñez, BorjaAceña, Álvaro2024-11-292024-11-292024-08-25J Clin Med. 2024 Aug 25;13(17):5032.https://hdl.handle.net/20.500.12105/25831This study received funding from the Carlos III National Health Institute (ISCIII; PI19/00655 and PI20/00923 to A.A., O.L. and J.T.). A.D. is an Alfonso Martin Escudero fellow and is scientifically supported by La Caixa Foundation. B.I. is funded by the European Research Council (ERC) under the European Union Horizon 2020 Research and Innovation Program (ERC-Consolidator grant agreement no. 819775) and by the Ministry of Science and Innovation (RETOS 2019 grant no. PID2019-107332RBI00). The CNIC is supported by the ISCIII, the MCN, and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (SEV-2015-0505).ATTR-CM is becoming more prevalent, and disease-modifying therapy has been investigated in recent years with promising results. Diflunisal has shown TTR-stabilizing properties assessed by biomarkers and echocardiography, but there are no trials addressing the evolution of morphological changes with CMR. AMILCA-DIFLU is an exploratory pilot study prospective, single-center, non-randomized, open-label clinical trial. Patients diagnosed with ATTR-CM underwent clinical, functional, biochemical and imaging assessment before and one year after diflunisal therapy initiation. Of the twelve ATTR-CM patients included, only nine patients completed treatment and study protocol in 12 months. To increase the sample size, we included seven real-world patients with one year of diflunisal treatment. Among the group of patients who completed treatment, diflunisal therapy did not show improvement in cardiac disease status as assessed by many cardiac and inflammatory biomarkers, 6MWT and CMR parameters after one year of treatment. However, a non-significant trend towards stabilization of CMR parameters such as LVEF, ECV and T2 at one year was found. When comparing the group of patients who completed diflunisal therapy and those who did not, a significant decrease in the distance performed in the 6MWT was found in the group of patients who completed treatment at one year (-14 ± 81.8 vs. -173 ± 122.2; = 0.032). Diflunisal was overall well tolerated, showing only a statistically significant worsening in renal function in the group of diflunisal-treatment patients with no clinical relevance or need for treatment discontinuation. In patients with ATTR-CM, treatment with diflunisal was overall well tolerated and tended to stabilize or slow down amyloid cardiac disease progression assessed by CMR parameters, cardiac and inflammatory biomarkers and functional capacity.engVoRhttp://creativecommons.org/licenses/by/4.0/amyloiddiflunisalheart failurestabilizationtransthyretin cardiomyopathyAttribution 4.0 International3927424513175032Journal of Clinical Medicineopen access