Abstract
BackgroundThe global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing the ongoing coronavirus disease 2019 (COVID-19) pandemic has raised serious concern for patients with chronic disease. A correlation has been identified between the severity of COVID-19 and a patient’s preexisting comorbidities. Although COVID-19 primarily involves the respiratory system, dysfunction in multiple organ systems is common, particularly in the cardiovascular, gastrointestinal, immune, renal, and nervous systems. Patients with amyloid transthyretin (ATTR) amyloidosis represent a population particularly vulnerable to COVID-19 morbidity due to the multisystem nature of ATTR amyloidosis.Main bodyATTR amyloidosis is a clinically heterogeneous progressive disease, resulting from the accumulation of amyloid fibrils in various organs and tissues. Amyloid deposition causes multisystem clinical manifestations, including cardiomyopathy and polyneuropathy, along with gastrointestinal symptoms and renal dysfunction. Given the potential for exacerbation of organ dysfunction, physicians note possible unique challenges in the management of patients with ATTR amyloidosis who develop multiorgan complications from COVID-19. While the interplay between COVID-19 and ATTR amyloidosis is still being evaluated, physicians should consider that the heightened susceptibility of patients with ATTR amyloidosis to multiorgan complications might increase their risk for poor outcomes with COVID-19.ConclusionPatients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be balanced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimizing treatment interruptions.
Highlights
Specialty‐specific perspectives on the anticipated impact of COVID‐19 in patients with amyloid transthyre‐ tin (ATTR) amyloidosis Given the multisystem clinical manifestations of ATTR amyloidosis, specialty-specific challenges are anticipated for physicians managing patients with ATTR amyloidosis who develop multiorgan complications from COVID19
Pulmonary The respiratory distress caused by COVID-19 will likely have a severe impact on patients with ATTR amyloidosis, as amyloid fibril infiltration can be found throughout the respiratory tract at autopsy, and patients with cardiac involvement of ATTR (ATTR-CM) may have pre-existing chronic elevation of pulmonary venous pressure
Overall, physicians from all specialties concluded that patients with ATTR amyloidosis who develop COVID19 have a higher risk of mortality, due to age and other comorbidities, such as hypertension and diabetes, necessitating additional precautions and specialized management (Table 2)
Summary
Patients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be bal‐ anced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct. Brannagan III et al Orphanet J Rare Dis (2021) 16:204 for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimiz‐ ing treatment interruptions
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