Highlights
- •We performed diflunisal therapy for late-onset FAP in a Japanese endemic area.
- •The treatment resulted in improvement of autonomic symptoms, and maintenance of mBMI.
- •Delayed H/M ratios on 123I-MIBG imaging increased significantly.
- •Motor and sensory symptoms gradually deteriorated.
- •There was no adverse event of diflunisal except reversible hematuria in a patient.
Abstract
Objective
To evaluate the long-term efficacy and safety of diflunisal in late-onset familial
amyloid polyneuropathy (FAP) in a Japanese endemic area.
Methods
Consecutive six FAP patients (mean age: 65.8 ± 7.3 years) with a transthyretin (TTR) Val30Met mutation from an endemic area of late-onset
FAP were prospectively recruited to an open label study with oral diflunisal (250 mg twice a day). We evaluated clinical symptoms, Kumamoto FAP score, modified body
mass index (mBMI), Medical Research Council sum score, nerve conduction studies (NCS),
electrocardiogram (ECG), ECG Holter monitor test, echocardiography, and 123iodine-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy.
Results
One patient ceased to take diflunisal because of hematuria which was reversible. The
other five patients were treated with diflunisal for 3–5 (4.4 ± 0.9 years) years. Autonomic symptoms (orthostatic hypotension and gastrointestinal symptoms)
disappeared after treatment in two of the four patients with the symptoms. Delayed
heart to mediastinum ratio on 123I-MIBG imaging, a marker of cardiac postganglionic sympathetic nerve function, increased
during the three-year treatment. mBMI was maintained through observation period. While,
motor and sensory symptoms, Kumamoto FAP scores, and data on NCS gradually deteriorated.
Conclusion
Diflunisal might be effective especially for autonomic dysfunction in late-onset FAP
with a TTR Val30Met mutation.
Abbreviations:
ATTR (transthyretin-related amyloid), AV (atrioventricular), DcT (deceleration time), E/A ratio (ratio of mitral peak velocity of early filling to mitral peak velocity of late filling), E/e′ ratio (ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e′)), EF (ejection fraction), FAP (familial amyloid polyneuropathy), H/M (heart to mediastinum), 123I-MIBG (123iodine-metaiodobenzylguanidine), IVST (interventricular septal thickness), LAD (left atrial dimension), LT (liver transplantation), LV (left ventricular), mBMI (modified body mass index), MRC (Medical Research Council), NCS (nerve conduction studies), OH (orthostatic hypotension), PWT (posterior wall thickness), TTR (transthyretin), TTR (transthyretin gene)Keywords
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Article info
Publication history
Published online: July 14, 2014
Accepted:
July 7,
2014
Received in revised form:
July 3,
2014
Received:
May 10,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
