Cardiac Biomarkers Predict Quality of Life in Patients With Light-Chain Amyloidosis

In a study presented at the 23rd Congress of the European Hematology Association, researchers demonstrated a relationship between B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) and health-related quality of life (HRQoL) in patients with light-chain (AL) amyloidosis. These cardiac measures are “commonly used to monitor disease progression and response to treatment among patients with cardiac involvement from AL amyloidosis,” reported the authors, led by Kristen L. McCausland, PhD, MPH, of Optum in Providence, Rhode Island.

This study’s findings suggest that BNP and NT-proBNP could act as surrogate measures for HRQoL and disease burden in this patient population. “This study is an important first step in examining the relationship between changes in cardiac biomarkers, particularly NT-proBNP, and HRQoL in patients with AL amyloidosis,” said study researcher and presenter Tiffany P. Quock, PhD, of Prothena Biosciences in San Francisco. “Patients with AL amyloidosis who experienced a self-reported cardiac response to treatment reported better HRQoL as compared to patients without a cardiac treatment response.”

Drs. McCausland, Quock, and colleagues examined the relationship between cardiac biomarkers and patients’ HRQoL in two data sources: a community-based sample (n=108) and clinical sample of patients with AL amyloidosis receiving hospital care (n=95).

HRQoL was measured by patient-reported surveys (the 36-Item Short Form Health Survey [SF-36] and a short form of the Kansas City Cardiomyopathy Questionnaire [KCCQ-12]), then compared between patients with and without declines in BNP and NT-proBNP of ≥30 percent.

Individuals in the community-based sample who reported an NT-proBNP response (n=75) demonstrated significantly greater HRQoL, compared with individuals without a response (n=33), based on all SF-36 and KCCQ- 12 scores (p<0.05 for all). However, for those without an NT-proBNP response, scores on the SF-36 were similar to benchmark scores for patients with congestive heart failure. The researchers also identified potential long-term associations between cardiac biomarker changes and HRQoL score changes in the analysis of the clinical sample.

“To overcome some of the study’s limitations, we also conducted exploratory analyses based on a clinical sample,” said Dr. McCausland. “However further longitudinal research using NT-proBNP lab values from a larger sample is warranted.” Additionally, considering this study used self-report to identify cardiac response to treatment, she noted that future studies should use objective measures to evaluate treatment response in AL amyloidosis.

Based on these findings, Dr. McCausland stated that clinicians should rely on a combination of patient-reported outcomes and laboratory reports for identifying complementary and critical data on the well-being of patients with AL amyloidosis. “Despite reporting a cardiac response to treatment, treatment responders still experienced significant deficits in HRQoL, particularly in aspects related to physical health,” she said. “Using patient-reported outcomes in the clinical setting may help clinicians identify patients with these deficits in HRQoL and recommend supportive therapies.”

Corresponding authors report financial relationships with Prothena Biosciences, which supported the study.

Reference

McCausland KL, Guthrie S, Quock T, et al. Improvements in cardiac biomarkers are associated with better health-related quality of life in patients with light chain amyloidosis. Abstract #S147. Presented at the 23rd Congress of the European Hematology Association, June 15, 2018; Stockholm, Sweden.

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