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Do T, Riedl MA. Current and Emerging Therapeutics in Hereditary Angioedema. Immunol Allergy Clin North Am 2024; 44:561-576. [PMID: 38937016 DOI: 10.1016/j.iac.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Angioedema is characterized by transient movement of fluid from the vasculature into the interstitial space leading to subcutaneous or submucosal non-pitting edema. Current evidence suggests that most angioedema conditions can be grouped into 2 categories: mast cell-mediated (previously termed histaminergic) or bradykinin-mediated angioedema. Although effective therapies for mast cell-mediated angioedema have existed for decades, specific therapies for bradykinin-mediated angioedema have more recently been developed. In recent years, rigorous studies of these therapies in treating hereditary angioedema (HAE) have led to regulatory approvals of medication for HAE management thereby greatly expanding HAE treatment options.
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Affiliation(s)
- Toan Do
- Division of Allergy & Immunology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Marc A Riedl
- Division of Allergy & Immunology, University of California, San Diego, 8899 University Center Lane, Suite 230, La Jolla, CA 92122, USA.
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Lamacchia D, Nappi E, Marzio V, Locatelli F, Messina MR, Heffler E. Hereditary angioedema: current therapeutic management and future approaches. Curr Opin Allergy Clin Immunol 2024; 24:257-265. [PMID: 38743499 DOI: 10.1097/aci.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an account of the focus of therapeutic strategies for hereditary angioedema (HAE), give a brief overview of those used in the past and set aside and toughly discuss those currently available as first line. Further research is ongoing and the future therapeutic approaches that are still in different phases of study will be reviewed as well. RECENT FINDINGS In the last two decades, major research advancements on HAE pathophysiology and management were made and numerous novel therapeutic options are now available. Compared to the past, drugs available nowadays are more effective, well tolerated, and possibly have a more convenient administration route. Moreover, numerous other drugs with innovative mechanisms of action are under development. SUMMARY HAE is a rare genetic disease that if not promptly treated, it can lead to death from asphyxiation. Furthermore, due to its disfiguring and painful manifestations, HAE implies an important burden on the quality of life. Recently, following great research progresses on HAE therapy, evidence-based guidelines on HAE management were released. The therapeutic landscape of HAE is still under florid development, and it is possible novel treatments will remarkably revolutionize HAE management in the future.
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Affiliation(s)
- Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
| | - Emanuele Nappi
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
| | - Valentina Marzio
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Locatelli
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
| | - Maria Rita Messina
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
- Department of Biomedical Sciences, Humanitas University
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital
- Department of Biomedical Sciences, Humanitas University
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Riedl MA, Farkas H, Aygören-Pürsün E, Psarros F, Soteres DF, Staevska M, Cancian M, Hagin D, Honda D, Melamed I, Savic S, Stobiecki M, Busse PJ, Dias de Castro E, Agmon-Levin N, Gower R, Kessel A, Kurowski M, Lleonart R, Grivcheva Panovska V, Wedner HJ, Audhya PK, Hao J, Iverson M, Smith MD, Yea CM, Lumry WR, Zanichelli A, Bernstein JA, Maurer M, Cohn DM. Oral Sebetralstat for On-Demand Treatment of Hereditary Angioedema Attacks. N Engl J Med 2024; 391:32-43. [PMID: 38819658 DOI: 10.1056/nejmoa2314192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Approved on-demand treatments for hereditary angioedema attacks need to be administered parenterally, a route of administration that is associated with delays in treatment or withholding of therapy. METHODS In this phase 3, double-blind, three-way crossover trial, we randomly assigned participants at least 12 years of age with type 1 or type 2 hereditary angioedema to take up to two oral doses of sebetralstat (300 mg or 600 mg) or placebo for an angioedema attack. The primary end point, assessed in a time-to-event analysis, was the beginning of symptom relief, defined as a rating of "a little better" on the Patient Global Impression of Change scale (ratings range from "much worse" to "much better") at two or more consecutive time points within 12 hours after the first administration of the trial agent. Key secondary end points, assessed in a time-to-event analysis, were a reduction in attack severity (an improved rating on the Patient Global Impression of Severity [PGI-S] scale, with ratings ranging from "none" to "very severe") at two or more consecutive time points within 12 hours and complete attack resolution (a rating of "none" on the PGI-S scale) within 24 hours. RESULTS A total of 136 participants were assigned to one of six trial sequences, with 110 treating 264 attacks. The time to the beginning of symptom relief with the 300-mg dose and the 600-mg dose was faster than with placebo (P<0.001 and P = 0.001 for the two comparisons, respectively), with median times of 1.61 hours (interquartile range, 0.78 to 7.04), 1.79 hours (1.02 to 3.79), and 6.72 hours (1.34 to >12), respectively. The time to reduction in the attack severity with the 300-mg dose and the 600-mg dose was faster than with placebo (P = 0.004 and P = 0.003), with median times of 9.27 hours (interquartile range, 1.53 to >12), 7.75 hours (2.19 to >12), and more than 12 hours (6.23 to >12). The time to complete resolution was faster with the 300-mg and 600-mg doses than with placebo (P = 0.002 and P<0.001). The percentage of attacks with complete resolution within 24 hours was 42.5% with the 300-mg dose, 49.5% with the 600-mg dose, and 27.4% with placebo. Sebetralstat and placebo had similar safety profiles; no serious adverse events related to the trial agents were reported. CONCLUSIONS Oral sebetralstat provided faster times to the beginning of symptom relief, reduction in attack severity, and complete attack resolution than placebo. (Funded by KalVista Pharmaceuticals; KONFIDENT ClinicalTrials.gov number, NCT05259917; EudraCT number, 2021-001226-21.).
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Affiliation(s)
- Marc A Riedl
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Henriette Farkas
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Emel Aygören-Pürsün
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Fotis Psarros
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Daniel F Soteres
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Maria Staevska
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Mauro Cancian
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - David Hagin
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Daisuke Honda
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Isaac Melamed
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Sinisa Savic
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Marcin Stobiecki
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Paula J Busse
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Eunice Dias de Castro
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Nancy Agmon-Levin
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Richard Gower
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Aharon Kessel
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Marcin Kurowski
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Ramon Lleonart
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Vesna Grivcheva Panovska
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - H James Wedner
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Paul K Audhya
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - James Hao
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Matthew Iverson
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Michael D Smith
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Christopher M Yea
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - William R Lumry
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Andrea Zanichelli
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Jonathan A Bernstein
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Marcus Maurer
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
| | - Danny M Cohn
- From the Division of Allergy and Immunology, University of California, San Diego, La Jolla (M.A.R.); the Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary (H.F.); University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (E.A.-P.), and the Institute of Allergology, Charité-Universitätsmedizin Berlin, Freie Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, and Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology, Berlin (M.M.) - all in Germany; Naval Hospital of Athens, Athens (F.P.); Asthma and Allergy Associates, Colorado Springs (D.F.S.), and IMMUNOe Research Center, Centennial (I.M.) - both in Colorado; Clinical Center of Allergology, Clinic of Allergy and Asthma, University Hospital Alexandrovska, Medical University of Sofia, Sofia, Bulgaria (M.S.); the Department of Systems Medicine, University of Padua, Padua (M.C.), and Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, and Dipartimento di Scienze Biomediche per la salute, University of Milan, Milan (A.Z.) - all in Italy; Tel Aviv Sourasky Medical Center (D.H.) and Sheba Medical Center (N.A.-L.), Tel Aviv, and Bnai Zion Medical Center, Haifa (A.K.) - all in Israel; Chiba University Hospital, Chiba, Japan (D.H.); the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds (S.S.), and KalVista Pharmaceuticals, Salisbury (P.K.A., J.H., M.I., M.D.S., C.M.Y.) - both in the United Kingdom; Jagiellonian University Medical College, Krakow (M.S.), and Medical University of Lodz, Lodz (M.K.) - both in Poland; Icahn School of Medicine at Mount Sinai, New York (P.J.B.); Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, and Faculty of Medicine, University of Porto, Porto, Portugal (E.D.); Marycliff Clinical Research, Spokane, WA (R.G.); Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergology Department, Barcelona (R.L.); University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodus, Skopje, North Macedonia (V.G.P.); Washington University School of Medicine, St. Louis (H.J.W.); KalVista Pharmaceuticals, Cambridge, MA (P.K.A., J.H., M.I., M.D.S., C.M.Y.); AARA Research Center, Dallas (W.R.L.); the University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati (J.A.B.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (D.M.C.)
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Riedl MA, Tachdjian R, Lumry WR, Craig T, Karakaya G, Gelincik A, Stobiecki M, Jacobs JS, Gokmen NM, Reshef A, Gompels MM, Manning ME, Bordone L, Newman KB, Treadwell S, Wang S, Yarlas A, Cohn DM. Efficacy and Safety of Donidalorsen for Hereditary Angioedema. N Engl J Med 2024; 391:21-31. [PMID: 38819395 DOI: 10.1056/nejmoa2402478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Hereditary angioedema is a rare disorder characterized by episodic, potentially life-threatening swelling caused by kallikrein-kinin dysregulation. Long-term prophylaxis can stabilize this system. Donidalorsen, an antisense oligonucleotide, specifically reduces prekallikrein expression. METHODS In this phase 3, double-blind, randomized trial, we assigned patients with hereditary angioedema to receive donidalorsen (80 mg subcutaneously) or placebo once every 4 or 8 weeks. The primary end point was the time-normalized number of investigator-confirmed hereditary angioedema attacks per 4 weeks (attack rate) from week 1 to week 25. RESULTS A total of 90 patients received donidalorsen every 4 weeks (45 patients), donidalorsen every 8 weeks (23 patients), or placebo (22 patients). The least-squares mean time-normalized attack rate was 0.44 (95% CI, 0.27 to 0.73) in the 4-week group, 1.02 (95% CI, 0.65 to 1.59) in the 8-week group, and 2.26 (95% CI, 1.66 to 3.09) in the placebo group. The mean attack rate from week 1 to week 25 was 81% lower (95% CI, 65 to 89) in the 4-week group than in the placebo group (P<0.001) and 55% lower (95% CI, 22 to 74) in the 8-week group than in the placebo group (P = 0.004); the median reduction in the attack rate from baseline was 90% in the 4-week group, 83% in the 8-week group, and 16% in the placebo group. The mean attack rate during weeks 5 to 25 was 87% lower (95% CI, 72 to 94) in the 4-week group than in the placebo group (P<0.001) and 60% lower (95% CI, 25 to 79) in the 8-week group than in the placebo group. Donidalorsen administered every 4 weeks resulted in an improvement in the least-squares mean total score for the change at week 25 on the Angioedema Quality-of-Life Questionnaire (scores range from 0 to 100, with a score of 100 indicating the worst possible quality of life) that was 18.6 points (95% CI, 9.5 to 27.7) better than that with placebo (P<0.001). The most common adverse events were erythema at the injection site, headache, and nasopharyngitis; 98% of adverse events were mild or moderate in severity. CONCLUSIONS Donidalorsen treatment reduced the hereditary angioedema attack rate, a finding that supports potential prophylactic use for hereditary angioedema. (Funded by Ionis Pharmaceuticals; OASIS-HAE ClinicalTrials.gov number, NCT05139810.).
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Affiliation(s)
- Marc A Riedl
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Raffi Tachdjian
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - William R Lumry
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Timothy Craig
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Gül Karakaya
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Asli Gelincik
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Marcin Stobiecki
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Joshua S Jacobs
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Nihal M Gokmen
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Avner Reshef
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Mark M Gompels
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Michael E Manning
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Laura Bordone
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Kenneth B Newman
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Sabrina Treadwell
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Sophie Wang
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Aaron Yarlas
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
| | - Danny M Cohn
- From the Division of Allergy and Immunology, University of California at San Diego, La Jolla (M.A.R.), the Division of Allergy, Immunology, and Rheumatology, University of California at Los Angeles, Los Angeles (R.T.), Allergy and Asthma Clinical Research, Walnut Creek (J.S.J.), and Ionis Pharmaceuticals, Carlsbad (L.B., K.B.N., S.T., S.W., A.Y.) - all in California; Asthma and Allergy Research Associates, Dallas (W.R.L.); the Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State Health Allergy, Asthma, and Immunology, Hershey, PA (T.C.); Vinmec International Hospital, Hanoi (T.C.); the Division of Allergy and Immunology, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara (G.K.), the Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul (A.G.), and the Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, Ege University, Izmir (N.M.G.) - all in Turkey; the Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland (M.S.); the Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel (A.R.); the Department of Immunology, Southmead Hospital, North Bristol National Health (NHS) Trust, Bristol, United Kingdom (M.M.G.); Medical Research of Arizona, Scottsdale (M.E.M.); and the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam (D.M.C.)
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5
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Peters NE, Mac Lochlainn DJ, Dhalla F, Howarth L, Gupte GL, Sharif K, Jain R, Kelly D, Patel SY. Normalization of C1 Inhibitor in a Patient with Hereditary Angioedema. N Engl J Med 2024; 391:56-59. [PMID: 38959481 DOI: 10.1056/nejmoa2400403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Hereditary angioedema is a potentially life-threatening autosomal dominant condition, causing attacks of angioedema due to failure to regulate bradykinin. Nearly all cases of hereditary angioedema are caused by mutations in the gene encoding C1 inhibitor, SERPING1. C1 inhibitor is a multifunctional protein produced in the liver that regulates the kallikrein-kinin system at multiple points. An infant with genetically confirmed hereditary angioedema and low C1 inhibitor levels (but without previous episodes of angioedema) underwent liver transplantation for biliary atresia, an unrelated condition. Liver transplantation led to normalization of the C1 inhibitor level and function. To our knowledge, this represents the first patient to be potentially cured of hereditary angioedema.
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Affiliation(s)
- Nicholas E Peters
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Dylan J Mac Lochlainn
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Fatima Dhalla
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Lucy Howarth
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Girish L Gupte
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Khalid Sharif
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Rashmi Jain
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Dominic Kelly
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
| | - Smita Y Patel
- From the Departments of Clinical Immunology (N.E.P., D.J.M.L., F.D., R.J., S.Y.P.) and Pediatric Gastroenterology (L.H.), Oxford University Hospitals NHS Foundation Trust, and the Institute of Developmental and Regenerative Medicine (F.D.) and the Department of Paediatrics (F.D., D.K.), University of Oxford, Oxford, and the Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham (N.E.P.), and the Liver Unit, Birmingham Women's and Children's Hospital (G.L.G., K.S.), Birmingham - all in the United Kingdom
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6
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Sarkar A, Nwagwu C, Craig T. An Overview of Hereditary Angioedema for the Primary Care Physician. Med Clin North Am 2024; 108:747-755. [PMID: 38816115 DOI: 10.1016/j.mcna.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Hereditary angioedema is a rare autosomal dominant condition characterized by episodes of swelling of the upper airway, intestines, and skin. The disorder is characterized by deficiency in C1 esterase inhibitor (C1-INH) or a decrease in functional C1-INH. Treatment options include on demand therapy (treatment of acute attacks), long-term prophylaxis, and short-term prophylaxis. Corticosteroids, epinephrine, and antihistamines are not effective for this form of angioedema. The high mortality in patients undiagnosed underscores a need for broader physician awareness to identify these patients and initiate therapy.
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Affiliation(s)
- Arindam Sarkar
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77007, USA.
| | - Crystal Nwagwu
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77007, USA
| | - Timothy Craig
- Pediatrics and Biomedical Sciences, Penn State University, 500 University Drive, Hershey, PA 17033, USA
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7
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Singh S, Kachhawaha K, Singh SK. Comprehensive approaches to preclinical evaluation of monoclonal antibodies and their next-generation derivatives. Biochem Pharmacol 2024; 225:116303. [PMID: 38797272 DOI: 10.1016/j.bcp.2024.116303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
Biotherapeutics hold great promise for the treatment of several diseases and offer innovative possibilities for new treatments that target previously unaddressed medical needs. Despite successful transitions from preclinical to clinical stages and regulatory approval, there are instances where adverse reactions arise, resulting in product withdrawals. As a result, it is essential to conduct thorough evaluations of safety and effectiveness on an individual basis. This article explores current practices, challenges, and future approaches in conducting comprehensive preclinical assessments to ensure the safety and efficacy of biotherapeutics including monoclonal antibodies, toxin-conjugates, bispecific antibodies, single-chain antibodies, Fc-engineered antibodies, antibody mimetics, and siRNA-antibody/peptide conjugates.
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Affiliation(s)
- Santanu Singh
- Laboratory of Engineered Therapeutics, School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
| | - Kajal Kachhawaha
- Laboratory of Engineered Therapeutics, School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
| | - Sumit K Singh
- Laboratory of Engineered Therapeutics, School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, India.
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8
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Wan J, Dhrolia S, Kasthuri RR, Prokopenko Y, Ilich A, Saha P, Roest M, Wolberg AS, Key NS, Pawlinski R, Bendapudi PK, Mackman N, Grover SP. Plasma kallikrein supports FXII-independent thrombin generation in mouse whole blood. Blood Adv 2024; 8:3045-3057. [PMID: 38593231 PMCID: PMC11215197 DOI: 10.1182/bloodadvances.2024012613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024] Open
Abstract
ABSTRACT Plasma kallikrein (PKa) is an important activator of factor XII (FXII) of the contact pathway of coagulation. Several studies have shown that PKa also possesses procoagulant activity independent of FXII, likely through its ability to directly activate FIX. We evaluated the procoagulant activity of PKa using a mouse whole blood (WB) thrombin-generation (TG) assay. TG was measured in WB from PKa-deficient mice using contact pathway or extrinsic pathway triggers. PKa-deficient WB had significantly reduced contact pathway-initiated TG compared with that of wild-type controls and was comparable with that observed in FXII-deficient WB. PKa-deficient WB supported equivalent extrinsic pathway-initiated TG compared with wild-type controls. Consistent with the presence of FXII-independent functions of PKa, targeted blockade of PKa with either small molecule or antibody-based inhibitors significantly reduced contact pathway-initiated TG in FXII-deficient WB. Inhibition of activated FXII (FXIIa) using an antibody-based inhibitor significantly reduced TG in PKa-deficient WB, consistent with a PKa-independent function of FXIIa. Experiments using mice expressing low levels of tissue factor demonstrated that persistent TG present in PKa- and FXIIa-inhibited WB was driven primarily by endogenous tissue factor. Our work demonstrates that PKa contributes significantly to contact pathway-initiated TG in the complex milieu of mouse WB, and a component of this contribution occurs in an FXII-independent manner.
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Affiliation(s)
- Jun Wan
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, Jiangsu Institute of Hematology, Soochow University, Suzhou, China
| | - Sophia Dhrolia
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rohan R. Kasthuri
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuriy Prokopenko
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anton Ilich
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Prakash Saha
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College London, London, United Kingdom
| | - Mark Roest
- Synapse Research Institute, Maastricht, The Netherlands
| | - Alisa S. Wolberg
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nigel S. Key
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rafal Pawlinski
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pavan K. Bendapudi
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Hematology and Blood Transfusion Service, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nigel Mackman
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steven P. Grover
- UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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9
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Hioki C, Oda Y, Moriwaki S, Fukunaga A. Effect of lanadelumab on attack frequency and QoL in Japanese patients with hereditary angioedema: Report of five cases. J Dermatol 2024; 51:873-877. [PMID: 38268496 DOI: 10.1111/1346-8138.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/07/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024]
Abstract
Lanadelumab, a recombinant human anti-kallikrein monoclonal antibody, is recommended as the first-line option for long-term prophylaxis (LTP) in hereditary angioedema (HAE). However, the efficacy of lanadelumab and its effects on the quality of life (QoL) in Japanese HAE patients using real-world data have not been reported. Herein, we report the outcomes of five HAE patients who were treated with lanadelumab at two Japanese institutions. We retrospectively collected data on attack frequency and on-demand treatment frequency using an angioedema quality of life (AE-QoL) questionnaire. Our data corresponded to five Japanese HAE patients who started lanadelumab treatment: four with HAE due to C1-inhibitor deficiency (HAE-1) and one with HAE with a normal C1-inhibitor (HAE-nC1-INH). Two HAE-1 patients showed a reduction in both attacks and number of on-demand treatments. The other HAE-1 patients had an increase in the number of on-demand treatments, although there was no apparent reduction in attacks. The HAE-nC1-INH patient showed a slight increase in both attacks and number of on-demand treatments. Only one HAE-1 patient discontinued treatment after 1 month owing to side effects, including dizziness and headache. All four who continued treatment showed improved AE-QoL total and domain scores. Therefore, in this study, using real-world data, we demonstrated that lanadelumab reduced attack frequency and improved QoL in Japanese HAE patients.
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Affiliation(s)
- Chika Hioki
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshiko Oda
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Moriwaki
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Atsushi Fukunaga
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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10
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Sexton D, Nguyen HQ, Juethner S, Luo H, Zhang Z, Jasper P, Zhu AZX. A quantitative systems pharmacology model of plasma kallikrein-kinin system dysregulation in hereditary angioedema. J Pharmacokinet Pharmacodyn 2024:10.1007/s10928-024-09919-6. [PMID: 38734778 DOI: 10.1007/s10928-024-09919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/09/2024] [Indexed: 05/13/2024]
Abstract
Hereditary angioedema (HAE) due to C1-inhibitor deficiency is a rare, debilitating, genetic disorder characterized by recurrent, unpredictable, attacks of edema. The clinical symptoms of HAE arise from excess bradykinin generation due to dysregulation of the plasma kallikrein-kinin system (KKS). A quantitative systems pharmacology (QSP) model that mechanistically describes the KKS and its role in HAE pathophysiology was developed based on HAE attacks being triggered by autoactivation of factor XII (FXII) to activated FXII (FXIIa), resulting in kallikrein production from prekallikrein. A base pharmacodynamic model was constructed and parameterized from literature data and ex vivo assays measuring inhibition of kallikrein activity in plasma of HAE patients or healthy volunteers who received lanadelumab. HAE attacks were simulated using a virtual patient population, with attacks recorded when systemic bradykinin levels exceeded 20 pM. The model was validated by comparing the simulations to observations from lanadelumab and plasma-derived C1-inhibitor clinical trials. The model was then applied to analyze the impact of nonadherence to a daily oral preventive therapy; simulations showed a correlation between the number of missed doses per month and reduced drug effectiveness. The impact of reducing lanadelumab dosing frequency from 300 mg every 2 weeks (Q2W) to every 4 weeks (Q4W) was also examined and showed that while attack rates with Q4W dosing were substantially reduced, the extent of reduction was greater with Q2W dosing. Overall, the QSP model showed good agreement with clinical data and could be used for hypothesis testing and outcome predictions.
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Affiliation(s)
- Dan Sexton
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Hoa Q Nguyen
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Salomé Juethner
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | | | | | | | - Andy Z X Zhu
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
- Preclinical and Translational Science Department, Takeda Pharmaceutical Company Limited, 35 Landsdowne Street, Cambridge, MA, 02139, USA.
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11
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Buttgereit T, Vera Ayala C, Aykanat S, Weller K, Gutsche A, Maurer M, Magerl M. The real life experience goes on: update after 4 years on the first cohort treated with lanadelumab at our center. Front Immunol 2024; 15:1405317. [PMID: 38799421 PMCID: PMC11116806 DOI: 10.3389/fimmu.2024.1405317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Lanadelumab is a first-line long-term prophylaxis (LTP) in hereditary angioedema (HAE). Real-life data on its long-term efficacy and safety are limited. It is unknown whether patients using lanadelumab need short-term prophylaxis (STP). Objectives To provide 4-year follow-up data for our first 34 patients treating with lanadelumab. Methods Patients were assessed for their current injection interval, attacks, treatment satisfaction, disease control (AECT), quality of life impairment (AE-QoL), events that can induce attacks, and the use of STP since the start of their treatment with lanadelumab. Results Of 34 patients who started lanadelumab treatment, 32 were still using it after 4 years, with a median injection interval of 33 (range 14-90) days. HAE patients (n=28) reported longer intervals, i.e. 35 (14-90) days, than patients with angioedema due to acquired C1 inhibitor deficiency (n=4, 23 (14-31) days). With their current injection intervals, used for a mean duration of 29 ± 17 months, patients reported a yearly attack rate of 0.3 ± 0.1. More than 70% of patients were attack-free since starting their current injection interval. All patients reported well-controlled disease, i.e. ≥10 points in the AECT; 21 patients had complete control (16 points). AE-QoL scores improved further compared to our initial report, most prominently in the fears/shame domain (-6 points). Treatment satisfaction was very high. No angioedema occurred after 146 of 147 potentially attack-inducing medical procedures without STP. Conclusions Our results demonstrate the long-term efficacy and safety of lanadelumab in real-life and question the need for STP in patients who use effective LTP.
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Affiliation(s)
- Thomas Buttgereit
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Carolina Vera Ayala
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Seda Aykanat
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Karsten Weller
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Annika Gutsche
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Markus Magerl
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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12
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Giavina-Bianchi P, Vivolo Aun M, Giavina-Bianchi M, Ribeiro AJ, Camara Agondi R, Motta AA, Kalil J. Hereditary angioedema classification: Expanding knowledge by genotyping and endotyping. World Allergy Organ J 2024; 17:100906. [PMID: 38818086 PMCID: PMC11137532 DOI: 10.1016/j.waojou.2024.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 06/01/2024] Open
Abstract
Hereditary angioedema (HAE) encompasses a group of diseases characterized by recurrent, genetically mediated angioedema associated with increased vascular permeability primarily due to bradykinin. The disease poses diagnostic challenges, leading to underdiagnosis and delayed therapy. Severe manifestations include laryngeal and intestinal angioedema, contributing to significant morbidity and mortality. If left undiagnosed, the estimated mortality rate of the disease ranges from 25% to 40% due to asphyxiation caused by laryngeal angioedema. There is a pressing need to enhance awareness of hereditary angioedema and its warning signs. The acronym "H4AE" may facilitate the memorization of these signs. This study comprehensively reviews clinical, laboratory, and physiopathological features of documented HAE subtypes. The study advocates for an improved HAE classification based on endotypes, building on the knowledge of angioedema pathophysiology. The proposed endotype classification of HAE offers a clear and applicable framework, encouraging advancements in disease understanding and classification.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Brazil
| | - Mara Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
- Hospital Israelita Albert Einstein, Brazil
| | - Ana Júlia Ribeiro
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
| | - Rosana Camara Agondi
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
| | - Antônio Abílio Motta
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
| | - Jorge Kalil
- Clinical Immunology and Allergy Division, University of São Paulo School of Medicine, Brazil
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13
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Schlueter M, Nestler-Parr S. Letter to the editor: network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema. J Comp Eff Res 2024; 13:e230165. [PMID: 38545965 PMCID: PMC11036881 DOI: 10.57264/cer-2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Max Schlueter
- IQVIA, The Point, 37 North Wharf Road, London, W2 1AF, UK
| | - Sandra Nestler-Parr
- BioCryst Pharmaceuticals, 4505 Emperor Blvd., Suite 200, Durham, NC 27703, USA
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14
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Troldborg A, Godnic-Polai Z, Cervenak L, Hansen AG, Farkas H, Thiel S. Inter-α-trypsin inhibitor heavy chain 4 (ITIH4) as a compensatory protease inhibitor in hereditary angioedema. J Allergy Clin Immunol 2024:S0091-6749(24)00405-6. [PMID: 38657796 DOI: 10.1016/j.jaci.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a genetic disorder that manifests as recurrent angioedema attacks, most frequently due to absent or reduced C1 inhibitor (C1INH) activity. C1INH is a crucial regulator of enzymatic cascades in the complement, fibrinolytic, and contact systems. Inter-α-trypsin inhibitor heavy chain 4 (ITIH4) is an abundant plasma protease inhibitor that can inhibit enzymes in the proteolytic pathways associated with HAE. Nothing is known about its role in HAE. OBJECTIVE We investigated ITIH4 activation in HAE, establishing it as a potential biomarker, and explored its involvement in HAE-associated proteolytic pathways. METHODS Specific immunoassays for noncleaved ITIH4 (intact ITIH4) and an assay detecting both intact and cleaved ITIH4 (total ITIH4) were developed. We initially tested serum samples from HAE patients (n = 20), angiotensin-converting enzyme inhibitor-induced edema patients (ACEI) (n = 20), and patients with HAE of unknown cause (HAE-UNK) (n = 20). Validation involved an extended cohort of 80 HAE patients (60 with HAE-C1INH type 1, 20 with HAE-C1INH type 2), including samples taken during attack and quiescent disease periods, as well as samples from 100 healthy controls. RESULTS In 63% of HAE patients, intact ITIH4 assay showed lower signals than total ITIH4 assay. This difference was not observed in ACEI and HAE-UNK patients. Western blot analysis confirmed cleaved ITIH4 with low intact ITIH4 samples. In serum samples lacking intact endogenous ITIH4, we observed immediate cleavage of added recombinant ITIH4, suggesting continuous enzymatic activity in the serum. Confirmatory HAE cohort analysis revealed significantly lower intact ITIH4 levels in both type 1 and type 2 HAE patients compared to controls, with consistently low intact/total ITIH4 ratios during clinical HAE attacks. CONCLUSION The disease-specific low intact ITIH4 levels highlight its unique nature in HAE. ITIH4 may exhibit compensatory mechanisms in HAE, suggesting its utility as a diagnostic and prognostic biomarker. The variations during quiescent and active disease periods raise intriguing questions about the dynamics of proteolytic pathways in HAE.
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Affiliation(s)
- Anne Troldborg
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
| | - Zsofia Godnic-Polai
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - László Cervenak
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | | | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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15
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Petersen RS, Bordone L, Riedl MA, Tachdjian R, Craig TJ, Lumry WR, Manning ME, Bernstein JA, Raasch J, Zuraw BL, Deng Y, Newman KB, Alexander VJ, Lui C, Schneider E, Cohn DM. A phase 2 open-label extension study of prekallikrein inhibition with donidalorsen for hereditary angioedema. Allergy 2024; 79:724-734. [PMID: 38009241 DOI: 10.1111/all.15948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a potentially fatal disease characterized by unpredictable, recurrent, often disabling swelling attacks. In a randomized phase 2 study, donidalorsen reduced HAE attack frequency and improved patient quality-of-life (ISIS721744-CS2, NCT04030598). We report the 2-year interim analysis of the phase 2 open-label extension (OLE) study (ISIS 721744-CS3, NCT04307381). METHODS In the OLE, the on-treatment study period consisted of fixed (weeks 1-13, donidalorsen 80 mg subcutaneously every 4 weeks [Q4W]) and flexible (weeks 17-105, donidalorsen 80 mg Q4W, 80 mg every 8 weeks [Q8W], or 100 mg Q4W) dosing periods. The primary outcome was incidence and severity of treatment-emergent adverse events (TEAEs). The secondary outcomes included efficacy, pharmacodynamic, and quality-of-life assessments. RESULTS Seventeen patients continued in the OLE study. No serious TEAEs or TEAEs leading to treatment discontinuation were reported. Mean monthly HAE attack rate was 96% lower than the study run-in baseline rate (mean, 0.06/month; 95% confidence interval [CI], 0.02-0.10; median, 0.04 on-treatment vs. mean, 2.70/month; 95% CI, 1.94-3.46; median, 2.29 at baseline). Mean monthly attack rate for Q8W dosing (n = 8) was 0.29 (range, 0.0-1.7; 95% CI, -0.21 to 0.79; median, 0.00). Mean plasma prekallikrein and D-dimer concentrations decreased, and Angioedema Quality of Life Questionnaire total score improved from baseline to week 105 with donidalorsen. CONCLUSION The 2-year interim results of this phase 2 OLE study of donidalorsen in patients with HAE demonstrated no new safety signals; donidalorsen was well tolerated. There was durable efficacy with a 96% reduction in HAE attacks.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Bordone
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Marc A Riedl
- University of California San Diego, La Jolla, California, USA
| | - Raffi Tachdjian
- Department of Pediatrics, University of California, Los Angeles, California, USA
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
- Vinmec International Hospital, Times City, Hanoi, Vietnam
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, Texas, USA
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Jason Raasch
- Midwest Immunology Clinic, Plymouth, Minnesota, USA
| | - Bruce L Zuraw
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Yiwen Deng
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | | | - Cindy Lui
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Kiani-Alikhan S, Gower R, Craig T, Wedner HJ, Kinaciyan T, Aygören-Pürsün E, Banerji A, Bernstein JA, Anderson J, Collis P, Johnston DT, Desai B, Tomita D, Gagnon R, Tachdjian R, Soteres DF, Farkas H, Caballero T, McNeil D, Jacobs J, Lumry WR. Once-Daily Oral Berotralstat for Long-Term Prophylaxis of Hereditary Angioedema: The Open-Label Extension of the APeX-2 Randomized Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:733-743.e10. [PMID: 38122865 DOI: 10.1016/j.jaip.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/20/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Berotralstat is a first-line, once-daily oral plasma kallikrein inhibitor approved for prophylaxis of hereditary angioedema (HAE) attacks in patients 12 years or older. OBJECTIVE This analysis examined the safety and effectiveness of long-term prophylaxis with berotralstat. METHODS APeX-2 was a phase 3, parallel-group, multicenter trial in patients with HAE caused by C1-inhibitor deficiency (NCT03485911). Part 1 was a randomized, double-blind, placebo-controlled evaluation of 150 and 110 mg of berotralstat over 24 weeks. In part 2, berotralstat-treated patients continued the same treatment, and placebo-treated patients were re-randomized to 150 or 110 mg of berotralstat for 24 weeks. In part 3, all patients were treated with open-label berotralstat at 150 mg, which could be continued for up to an additional 4 years. In part 3, the primary endpoint was long-term safety and tolerability. Secondary endpoints included HAE attack rates and quality of life (QoL). RESULTS Eighty-one patients entered part 3. Treatment-emergent adverse events (TEAEs) occurred in 82.7% of patients, with most being mild or moderate in severity. The most common TEAEs were nasopharyngitis, urinary tract infection, abdominal pain, arthralgia, coronavirus infection, and diarrhea. Drug-related TEAEs occurred in 14.8% of patients, but none were serious. For patients who completed 96 weeks of berotralstat treatment (n = 70), the mean (standard error) change in attack rate from baseline was -2.21 (0.20) attacks/mo. Clinically meaningful improvements in QoL were also observed, with the largest improvements in the functioning domain. CONCLUSION Berotralstat was generally well tolerated, provided rapid and sustained reductions in HAE attacks and improved QoL over 96 weeks.
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Affiliation(s)
- Sorena Kiani-Alikhan
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Timothy Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pa
| | - H James Wedner
- Division of Allergy and Immunology, John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Emel Aygören-Pürsün
- Department for Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Aleena Banerji
- Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Jonathan A Bernstein
- Division of Immunology, Rheumatology, and Allergy, Department of Medicine, University of Cincinnati and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - John Anderson
- Clinical Research Center of Alabama, an affiliate of AllerVie Health, Birmingham, Ala
| | | | | | | | | | - Rémi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, QC, Canada
| | - Raffi Tachdjian
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, Calif
| | | | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Teresa Caballero
- Allergy Department, La Paz University Hospital, IdiPAZ Group 44, CSUR Angioedema Hereditario HULP, Madrid, Spain
| | | | - Joshua Jacobs
- Allergy & Asthma Clinical Research, Walnut Creek, Calif
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17
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Chan ED, King PT, Bai X, Schoffstall AM, Sandhaus RA, Buckle AM. The Inhibition of Serine Proteases by Serpins Is Augmented by Negatively Charged Heparin: A Concise Review of Some Clinically Relevant Interactions. Int J Mol Sci 2024; 25:1804. [PMID: 38339082 PMCID: PMC10855260 DOI: 10.3390/ijms25031804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Serine proteases are members of a large family of hydrolytic enzymes in which a particular serine residue in the active site performs an essential role as a nucleophile, which is required for their proteolytic cleavage function. The array of functions performed by serine proteases is vast and includes, among others, the following: (i) the ability to fight infections; (ii) the activation of blood coagulation or blood clot lysis systems; (iii) the activation of digestive enzymes; and (iv) reproduction. Serine protease activity is highly regulated by multiple families of protease inhibitors, known collectively as the SERine Protease INhibitor (SERPIN). The serpins use a conformational change mechanism to inhibit proteases in an irreversible way. The unusual conformational change required for serpin function provides an elegant opportunity for allosteric regulation by the binding of cofactors, of which the most well-studied is heparin. The goal of this review is to discuss some of the clinically relevant serine protease-serpin interactions that may be enhanced by heparin or other negatively charged polysaccharides. The paired serine protease-serpin in the framework of heparin that we review includes the following: thrombin-antithrombin III, plasmin-anti-plasmin, C1 esterase/kallikrein-C1 esterase inhibitor, and furin/TMPRSS2 (serine protease Transmembrane Protease 2)-alpha-1-antitrypsin, with the latter in the context of COVID-19 and prostate cancer.
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Affiliation(s)
- Edward D. Chan
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
- Department of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Paul T. King
- Medicine Monash Health, Monash University, Clayton, VIC 3800, Australia
| | - Xiyuan Bai
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
- Department of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Allen M. Schoffstall
- Department of Chemistry and Biochemistry, University of Colorado, Colorado Springs, CO 80918, USA
| | | | - Ashley M. Buckle
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia;
- Replay, San Diego, CA 92121, USA
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18
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Longhurst HJ, Lindsay K, Petersen RS, Fijen LM, Gurugama P, Maag D, Butler JS, Shah MY, Golden A, Xu Y, Boiselle C, Vogel JD, Abdelhady AM, Maitland ML, McKee MD, Seitzer J, Han BW, Soukamneuth S, Leonard J, Sepp-Lorenzino L, Clark ED, Lebwohl D, Cohn DM. CRISPR-Cas9 In Vivo Gene Editing of KLKB1 for Hereditary Angioedema. N Engl J Med 2024; 390:432-441. [PMID: 38294975 DOI: 10.1056/nejmoa2309149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Hereditary angioedema is a rare genetic disease that leads to severe and unpredictable swelling attacks. NTLA-2002 is an in vivo gene-editing therapy based on clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9. NTLA-2002 targets the gene encoding kallikrein B1 (KLKB1), with the goal of lifelong control of angioedema attacks after a single dose. METHODS In this phase 1 dose-escalation portion of a combined phase 1-2 trial of NTLA-2002 in adults with hereditary angioedema, we administered NTLA-2002 at a single dose of 25 mg, 50 mg, or 75 mg. The primary end points were the safety and side-effect profile of NTLA-2002 therapy. Secondary and exploratory end points included pharmacokinetics, pharmacodynamics, and clinical efficacy determined on the basis of investigator-confirmed angioedema attacks. RESULTS Three patients received 25 mg of NTLA-2002, four received 50 mg, and three received 75 mg. At all dose levels, the most common adverse events were infusion-related reactions and fatigue. No dose-limiting toxic effects, serious adverse events, grade 3 or higher adverse events, or clinically important laboratory findings were observed after the administration of NTLA-2002. Dose-dependent reductions in the total plasma kallikrein protein level were observed between baseline and the latest assessment, with a mean percentage change of -67% in the 25-mg group, -84% in the 50-mg group, and -95% in the 75-mg group. The mean percentage change in the number of angioedema attacks per month between baseline and weeks 1 through 16 (primary observation period) was -91% in the 25-mg group, -97% in the 50-mg group, and -80% in the 75-mg group. Among all the patients, the mean percentage change in the number of angioedema attacks per month from baseline through the latest assessment was -95%. CONCLUSIONS In this small study, a single dose of NTLA-2002 led to robust, dose-dependent, and durable reductions in total plasma kallikrein levels, and no severe adverse events were observed. In exploratory analyses, reductions in the number of angioedema attacks per month were observed at all dose levels. (Funded by Intellia Therapeutics; ClinicalTrials.gov number, NCT05120830.).
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Affiliation(s)
- Hilary J Longhurst
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Karen Lindsay
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Remy S Petersen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Lauré M Fijen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Padmalal Gurugama
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Maag
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - James S Butler
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mrinal Y Shah
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Adele Golden
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Yuanxin Xu
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Carri Boiselle
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Joseph D Vogel
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Ahmed M Abdelhady
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Michael L Maitland
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mark D McKee
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Jessica Seitzer
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Bo W Han
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Samantha Soukamneuth
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - John Leonard
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Laura Sepp-Lorenzino
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Eliana D Clark
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Lebwohl
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Danny M Cohn
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
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Allam J, Rockey DC, Sharara AI. A Swell Diagnosis. N Engl J Med 2024; 390:71-76. [PMID: 38169492 DOI: 10.1056/nejmcps2307935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Jad Allam
- From the Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon (J.A., A.I.S.); and the Digestive Disease Research Center, Medical University of South Carolina, Charleston (J.A., D.C.R.)
| | - Don C Rockey
- From the Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon (J.A., A.I.S.); and the Digestive Disease Research Center, Medical University of South Carolina, Charleston (J.A., D.C.R.)
| | - Ala I Sharara
- From the Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon (J.A., A.I.S.); and the Digestive Disease Research Center, Medical University of South Carolina, Charleston (J.A., D.C.R.)
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Magerl M, Schiffhorst G, Fanter L, Müller G, Hirche C, Berkemeier F, Aygören E. Patient-level indirect treatment comparison of lanadelumab versus pdC1-INH i.v. in hereditary angioedema patients: PATCH study. Allergy 2024; 79:215-224. [PMID: 37641968 DOI: 10.1111/all.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is an autosomal dominant inherited disease in which patients suffer from local attacks primarily affecting skin and gastrointestinal tract, and sometimes even the upper respiratory tract leading to asphyxiation. Since head-to-head trials between authorized treatments are lacking, this study compares efficacy and safety of lanadelumab and intravenous plasma-derived C1-esterase inhibitor (pdC1-INH i.v.) in HAE patients on long-term prophylaxis by means of an indirect treatment comparison. METHODS Efficacy and safety of lanadelumab against pdC1-INH i.v. were analyzed in a fully prespecified indirect comparison based on individual patient data (n = 231) from the HELP and CHANGE clinical trials. Primary and secondary efficacy endpoints were compared using a generalized linear model for count data. Confounding variables were identified a priori via systematic literature research and validated by clinical experts. Adjustment of confounders was implemented using a conditional regression model. RESULTS Lanadelumab showed a statistically significant improvement in reduction of HAE attack rates compared to pdC1-INH i.v. across multiple endpoints: Monthly attack rate of patients treated with lanadelumab was less than half compared to pdC1-INH i.v. (Rate ratio: 0.486; 95% CI: 0.253, 0.932). Monthly rate of laryngeal attacks was found to be five times lower for lanadelumab (Rate ratio: 0.2; 95% CI: 0.044, 0.915) and monthly rate of acute treated HAE attacks among lanadelumab patients was about one third of the attack rate of pdC1-INH i.v. patients (Rate ratio: 0.366; 95% CI: 0.185, 0.727). CONCLUSION This study contributes to current knowledge in the treatment of HAE by indicating a statistically significant reduction of HAE attacks under lanadelumab compared to pdC1-INH i.v.
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Affiliation(s)
- Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | | | - Lena Fanter
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Gerrit Müller
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | | | - Emel Aygören
- Universitätsklinikum Frankfurt, Frankfurt, Germany
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Maurer M, Lumry WR, Li HH, Aygören-Pürsün E, Busse PJ, Jacobs J, Nurse C, Ahmed MA, Watt M, Yu M. Lanadelumab in Patients 2 to Less Than 12 Years Old With Hereditary Angioedema: Results From the Phase 3 SPRING Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:201-211.e6. [PMID: 37730089 DOI: 10.1016/j.jaip.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Symptoms of hereditary angioedema (HAE) often first occur during childhood, and HAE attacks in children can be severe and substantially affect health-related quality of life (HRQoL). However, there are no approved long-term prophylaxis treatments for children aged less than 6 years. OBJECTIVE The SPRING Study (NCT04070326) evaluated the safety, pharmacokinetics, and efficacy of lanadelumab and HRQoL in patients aged 2 to less than 12 years. METHODS Over 52 weeks of treatment, patients aged 2 to less than 6 years received lanadelumab 150 mg every 4 weeks (Q4W) and patients aged 6 to less than 12 years received 150 mg every 2 weeks (Q2W) but could switch to Q4W if they were attack-free for 26 weeks. RESULTS We enrolled 21 patients (aged 2 to less than 6 years: n = 4; aged 6 to less than 12 years: n = 17), 20 of whom completed the study. There were no reported serious treatment-emergent adverse events or discontinuations resulting from such events. Treatment-emergent adverse events were reported for 17 patients (81.0%). The most common TEAE was injection site pain. Overall systemic exposure was comparable for both age groups. The mean (SD) attack rate during treatment decreased by 94.8% from baseline (1.84 [1.53] to 0.08 [0.17] attacks/mo), and 16 (76.2%) patients were attack-free. The attack rate reduction in both age groups was similar during the first 26-week fixed-dosing treatment. Seven patients switched from Q2W to Q4W and remained attack-free. A large, clinically meaningful increase in the Pediatric Quality of Life Inventory Generic Core Scale Total Score and a large increase in the Pediatric Quality of Life Inventory Generic Core Scale-Family Impact Module Total Score from baseline to end of study (better HRQoL) were observed. CONCLUSIONS Findings support safety, efficacy, and improved HRQoL with lanadelumab 150 mg Q2W and Q4W regimens for the prevention of HAE attacks in patients aged 2 to less than 12 years.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
| | | | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, Md
| | - Emel Aygören-Pürsün
- Department for Children and Adolescents, Angioedema Centre, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Jacobs
- Allergy and Asthma Clinical Research, Walnut Creek, Calif
| | | | - Mariam A Ahmed
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Maureen Watt
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Ming Yu
- Takeda Development Center Americas, Inc, Lexington, Mass
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Clermont AC, Murugesan N, Edwards HJ, Lee DK, Bayliss NP, Duckworth EJ, Pethen SJ, Hampton SL, Gailani D, Feener EP. Oral FXIIa inhibitor KV998086 suppresses FXIIa and single chain FXII mediated kallikrein kinin system activation. Front Pharmacol 2023; 14:1287487. [PMID: 38178859 PMCID: PMC10766353 DOI: 10.3389/fphar.2023.1287487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background: The kallikrein kinin system (KKS) is an established pharmacological target for the treatment and prevention of attacks in hereditary angioedema (HAE). Proteolytic activities of FXIIa and single-chain Factor XII (FXII) zymogen contribute to KKS activation and thereby may play roles in both initiating and propagating HAE attacks. In this report, we investigated the effects of potent small molecule FXIIa inhibitors on FXIIa and single chain FXII enzymatic activities, KKS activation, and angioedema in mice. Methods: We examined the effects of 29 structurally distinct FXIIa inhibitors on enzymatic activities of FXIIa and a mutant single chain FXII with R334A, R343A and R353A substitutions (rFXII-T), that does not undergo zymogen conversion to FXIIa, using kinetic fluorogenic substrate assays. We examined the effects of a representative FXIIa inhibitor, KV998086, on KKS activation and both carrageenan- and captopril-induced angioedema in mice. Results: FXIIa inhibitors designed to target its catalytic domain also potently inhibited the enzymatic activity of rFXII-T and the pIC50s of these compounds linearly correlated for rFXIIa and rFXII-T (R 2 = 0.93). KV998086, a potent oral FXIIa inhibitor (IC50 = 7.2 nM) inhibited dextran sulfate (DXS)-stimulated generation of plasma kallikrein and FXIIa, and the cleavage of high molecular weight kininogen (HK) in human plasma. KV998086 also inhibited rFXII-T mediated HK cleavage (p < 0.005) in plasma from FXII knockout mice supplemented with rFXII-T and stimulated with polyphosphate or DXS. Orally administered KV998086 protected mice from 1) captopril-induced Evans blue leakage in colon and laryngotracheal tissues and 2) blocked carrageenan-induced plasma HK consumption and paw edema. Conclusion: These findings show that small molecule FXIIa inhibitors, designed to target its active site, also inhibit the enzymatic activity of FXII zymogen. Combined inhibition of FXII zymogen and FXIIa may thereby suppress both the initiation and amplification of KKS activation that contribute to hereditary angioedema attacks and other FXII-mediated diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David Gailani
- Hematology/Oncology Division, Vanderbilt University, Nashville, TN, United States
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23
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Niazi SK. A Critical Analysis of the FDA's Omics-Driven Pharmacodynamic Biomarkers to Establish Biosimilarity. Pharmaceuticals (Basel) 2023; 16:1556. [PMID: 38004421 PMCID: PMC10675618 DOI: 10.3390/ph16111556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/26/2023] Open
Abstract
Demonstrating biosimilarity entails comprehensive analytical assessment, clinical pharmacology profiling, and efficacy testing in patients for at least one medical indication, as required by the U.S. Biologics Price Competition and Innovation Act (BPCIA). The efficacy testing can be waived if the drug has known pharmacodynamic (PD) markers, leaving most therapeutic proteins out of this concession. To overcome this, the FDA suggests that biosimilar developers discover PD biomarkers using omics technologies such as proteomics, glycomics, transcriptomics, genomics, epigenomics, and metabolomics. This approach is redundant since the mode-action-action biomarkers of approved therapeutic proteins are already available, as compiled in this paper for the first time. Other potential biomarkers are receptor binding and pharmacokinetic profiling, which can be made more relevant to ensure biosimilarity without requiring biosimilar developers to conduct extensive research, for which they are rarely qualified.
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Affiliation(s)
- Sarfaraz K Niazi
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois, Chicago, IL 60612, USA
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24
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Burton AE, Lindsay-Wiles I, Herron D, Owen A, Elliott J, Metcalfe A, Diwakar L. Hereditary Angioedema patient experiences of medication use and emergency care. Int Emerg Nurs 2023; 71:101339. [PMID: 37713946 DOI: 10.1016/j.ienj.2023.101339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare inherited illness characterised by recurrent swellings. Four percent of HAE attacks are life threatening throat swellings requiring urgent medical intervention. The aim of this study was to gain an in depth understanding of patient experiences of use of treatment and emergency care. METHODS 65 participants completed an online survey including open ended questions about their experiences and/or completed an in-depth interview. Interview participants were asked to share and talk about up to five images that they felt best represented their life experiences with HAE. Data were analysed using reflexive thematic analysis. RESULTS Treatment experiences highlighted the life changing nature of new treatments and benefits for quality of life, but also illustrated common barriers to treatment administration. Emergency care experiences illustrated how throat attacks and fear of their future occurrence could be traumatic. DISCUSSION Findings indicate that HAE patients need psychological support to process fears and negative experiences. In addition, psychological barriers to treatment administration must be addressed to ensure treatment is used effectively. Education for emergency practitioners is also needed to improve emergency treatment and reduce the psychological burden of delayed emergency care.
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Affiliation(s)
| | | | - Daniel Herron
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Alison Owen
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Jade Elliott
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | | | - Lavanya Diwakar
- University Hospitals of North Midlands NHS Trust, United Kingdom
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25
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Hide M, Ohsawa I, Nurse C, Yu M. Efficacy and safety of lanadelumab in Japanese patients with hereditary angioedema: A phase 3 multicenter, open-label study. J Dermatol 2023; 50:1381-1391. [PMID: 37574953 DOI: 10.1111/1346-8138.16909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
The safety and efficacy of lanadelumab for the prevention of hereditary angioedema (HAE) attacks have not been studied in Japanese patients. We report outcomes from a phase 3, multicenter, open-label study (NCT04180163) of lanadelumab in Japanese patients with HAE. Japanese patients with HAE aged ≥12 years with ≥1 investigator-confirmed HAE attack during the 4-week run-in baseline period were enrolled into the study and received lanadelumab 300 mg every 2 weeks subcutaneously for 52 weeks. Dosing could be reduced to 300 mg every 4 weeks during the second 26-week treatment period if patients had well-controlled symptoms (e.g., attack-free) for 6 months. The primary efficacy endpoint was no investigator-confirmed HAE attacks (attack-free status) during days 0-182. Other outcomes included the rate of investigator-confirmed HAE attacks per month (28 days) and lanadelumab safety. Twelve patients (mean ± SD age 41.9 ± 12.4 years) were enrolled. During the first 26 weeks (days 0-182), five (41.7%) patients were attack-free. The mean ± SD HAE attack rate per month decreased by 74.0%, from 3.8 ± 2.4 during baseline to 1.2 ± 2.6 during the overall 52-week treatment period. There were no deaths or discontinuations due to treatment-emergent adverse events (TEAEs), no severe or serious TEAEs related to lanadelumab, and no positive anti-drug antibody results. The most frequent TEAEs were injection-site reactions (37 events in six patients). Most of the injection-site reaction adverse events were mild in severity. Results of this study support the findings from two global phase 3 studies for lanadelumab use as prophylactic therapy in Japanese patients with HAE.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Isao Ohsawa
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, Soka, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Christina Nurse
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Ming Yu
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
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26
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Bedian V, Biris N, Omer C, Chung JK, Fuller J, Dagher R, Chandran S, Harwin P, Kiselak T, Violin J, Nichols A, Bista P. STAR-0215 is a Novel, Long-Acting Monoclonal Antibody Inhibitor of Plasma Kallikrein for the Potential Treatment of Hereditary Angioedema. J Pharmacol Exp Ther 2023; 387:214-225. [PMID: 37643795 DOI: 10.1124/jpet.123.001740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by a deficiency in functional C1 esterase inhibitor, a serpin family protein that blocks the activity of plasma kallikrein. Insufficient inhibition of plasma kallikrein results in the overproduction of bradykinin, a vasoactive inflammatory mediator that produces both pain and unpredictable swelling during HAE attacks, with potentially life-threatening consequences. We describe the generation of STAR-0215, a humanized IgG1 antibody with a long circulating half-life (t1/2) that potently inhibits plasma kallikrein activity, with a >1000-fold lower affinity for prekallikrein and no measurable inhibitory activity against other serine proteases. The high specificity and inhibitory effect of STAR-0215 is demonstrated through a unique allosteric mechanism involving N-terminal catalytic domain binding, destabilization of the activation domain, and reversion of the active site to the inactive zymogen state. The YTE (M252Y/S254T/T256E) modified fragment crystallizable (Fc) domain of STAR-0215 enhances pH-dependent neonatal Fc receptor binding, resulting in a prolonged t1/2 in vivo (∼34 days in cynomolgus monkeys) compared with antibodies without this modification. A single subcutaneous dose of STAR-0215 (≥100 mg) was predicted to be active in patients for 3 months or longer, based on simulations using a minimal physiologically based pharmacokinetic model. These data indicate that STAR-0215, a highly potent and specific antibody against plasma kallikrein with extended t1/2, is a potential agent for long-term preventative HAE therapy administered every 3 months or less frequently. SIGNIFICANCE STATEMENT: STAR-0215 is a YTE-modified immunoglobulin G1 monoclonal antibody with a novel binding mechanism that specifically and potently inhibits the enzymatic activity of plasma kallikrein and prevents the generation of bradykinin. It has been designed to be a long-lasting prophylactic treatment to prevent attacks of HAE and to decrease the burden of disease and the burden of treatment for people with HAE.
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Affiliation(s)
- Vahe Bedian
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Nikolaos Biris
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Charles Omer
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Jou-Ku Chung
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - James Fuller
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Rafif Dagher
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Sachin Chandran
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Peter Harwin
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Tomas Kiselak
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Jonathan Violin
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Andrew Nichols
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
| | - Pradeep Bista
- Quellis Biosciences, Waltham, Massachusetts (V.B., C.O., P.H., T.K., J.V.); Astria Therapeutics, Inc., Boston, Massachusetts (N.B., C.O., J.K.C., R.D., S.C., J.V., A.N., P.B.); and Helix Biostructures, Indianapolis, Indiana (J.F.)
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27
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Sharma P, Joshi RV, Pritchard R, Xu K, Eicher MA. Therapeutic Antibodies in Medicine. Molecules 2023; 28:6438. [PMID: 37764213 PMCID: PMC10535987 DOI: 10.3390/molecules28186438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Antibody engineering has developed into a wide-reaching field, impacting a multitude of industries, most notably healthcare and diagnostics. The seminal work on developing the first monoclonal antibody four decades ago has witnessed exponential growth in the last 10-15 years, where regulators have approved monoclonal antibodies as therapeutics and for several diagnostic applications, including the remarkable attention it garnered during the pandemic. In recent years, antibodies have become the fastest-growing class of biological drugs approved for the treatment of a wide range of diseases, from cancer to autoimmune conditions. This review discusses the field of therapeutic antibodies as it stands today. It summarizes and outlines the clinical relevance and application of therapeutic antibodies in treating a landscape of diseases in different disciplines of medicine. It discusses the nomenclature, various approaches to antibody therapies, and the evolution of antibody therapeutics. It also discusses the risk profile and adverse immune reactions associated with the antibodies and sheds light on future applications and perspectives in antibody drug discovery.
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Affiliation(s)
- Prerna Sharma
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA
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28
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Yong PFK, Coulter T, El-Shanawany T, Garcez T, Hackett S, Jain R, Kiani-Alikhan S, Manson A, Noorani S, Stroud C, Symons C, Sargur R, Steele C, Alachkar H, Anantharachagan A, Arkwright PD, Bernatoniene J, Bhole M, Brown L, Buckland M, Burns S, Chopra C, Darroch J, Drewe E, Edmonds J, Ekbote A, Elkhalifa S, Goddard S, Grosse-Kreul D, Gurugama P, Hague R, Herriot R, Herwadkar A, Hughes SM, Jones L, Lear S, McDermott E, Kham Murng SH, Price A, Redenbaugh V, Richter A, Riordan A, Shackley F, Stichbury J, Springett D, Tarzi MD, Thomas M, Vijayadurai P, Worth A. A National Survey of Hereditary Angioedema and Acquired C1 Inhibitor Deficiency in the United Kingdom. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2476-2483. [PMID: 37146882 DOI: 10.1016/j.jaip.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Detailed demographic data on people with hereditary angioedema (HAE) and acquired C1 inhibitor deficiency in the United Kingdom are relatively limited. Better demographic data would be beneficial in planning service provision, identifying areas of improvement, and improving care. OBJECTIVE To obtain more accurate data on the demographics of HAE and acquired C1 inhibitor deficiency in the United Kingdom, including treatment modalities and services available to patients. METHODS A survey was distributed to all centers in the United Kingdom that look after patients with HAE and acquired C1 inhibitor deficiency to collect these data. RESULTS The survey identified 1152 patients with HAE-1/2 (58% female and 92% type 1), 22 patients with HAE with normal C1 inhibitor, and 91 patients with acquired C1 inhibitor deficiency. Data were provided by 37 centers across the United Kingdom. This gives a minimum prevalence of 1:59,000 for HAE-1/2 and 1:734,000 for acquired C1 inhibitor deficiency in the United Kingdom. A total of 45% of patients with HAE were on long-term prophylaxis (LTP) with the most used medication being danazol (55% of all patients on LTP). Eighty-two percent of patients with HAE had a home supply of acute treatment with C1 inhibitor or icatibant. A total of 45% of patients had a supply of icatibant and 56% had a supply of C1 inhibitor at home. CONCLUSIONS Data obtained from the survey provide useful information about the demographics and treatment modalities used in HAE and acquired C1 inhibitor deficiency in the United Kingdom. These data are useful for planning service provision and improving services for these patients.
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Affiliation(s)
- Patrick F K Yong
- Department of Allergy and Clinical Immunology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom.
| | - Tanya Coulter
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tariq El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Tomaz Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Scott Hackett
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Ania Manson
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sadia Noorani
- Department of Immunology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Catherine Stroud
- Regional Department of Immunology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Christine Symons
- Department of Clinical Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Ravishankar Sargur
- Department of Clinical Immunology and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Cathal Steele
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Hana Alachkar
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ariharan Anantharachagan
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter D Arkwright
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Jolanta Bernatoniene
- Department of Paediatric Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malini Bhole
- Department of Immunology, The Dudley Group NHS Foundation Trust, Dudley, United Kingdom
| | - Lindsay Brown
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Matthew Buckland
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Siobhan Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charu Chopra
- Department of Clinical Immunology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - James Darroch
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Elizabeth Drewe
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jillian Edmonds
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Anjali Ekbote
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shuayb Elkhalifa
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Dorothea Grosse-Kreul
- Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Padmalal Gurugama
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rosie Hague
- Department of Paediatric Immunology and Infectious Diseases, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Richard Herriot
- Department of Immunology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Archana Herwadkar
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Hughes
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Laura Jones
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Sara Lear
- Department of Clinical Immunology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Elizabeth McDermott
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sai Hurng Kham Murng
- Department of Clinical Immunology, Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Arthur Price
- Department of Clinical Immunology and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Vyanka Redenbaugh
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Alex Richter
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Fiona Shackley
- Department of Immunology and Infectious Diseases, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Julia Stichbury
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Debbie Springett
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael D Tarzi
- Department of Immunology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Moira Thomas
- Department of Clinical Immunology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Pavaladurai Vijayadurai
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Austen Worth
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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29
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Fijen LM, Klein PCG, Cohn DM, Kanters TA. The Disease Burden and Societal Costs of Hereditary Angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2468-2475.e2. [PMID: 36990433 DOI: 10.1016/j.jaip.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND According to the current treatment guidelines, the goals of treatment of patients with hereditary angioedema (HAE) are to achieve total control of the disease and to normalize patients' lives. OBJECTIVE This study aims to establish the entire burden of HAE comprising disease control, treatment satisfaction, reductions in quality of life, and societal costs. METHODS Adult patients with HAE under treatment at the Dutch national center of reference completed a cross-sectional survey in 2021. The survey consisted of different questionnaires: angioedema-specific questionnaires (4-week Angioedema Activity Score and Angioedema Control Test), quality of life questionnaires (Angioedema Quality of Life [AE-QoL] questionnaire and EQ-5D-5L), the Treatment Satisfaction Questionnaire for Medication (TSQM), and societal costs questionnaires (iMTA Medical Consumption Questionnaire and iMTA Productivity Cost Questionnaire). RESULTS The response rate was 78% (69 of 88). The entire sample had a mean Angioedema Activity Score of 16.61, and 36% of participants had poorly controlled disease as expressed by the Angioedema Control Test. The mean quality of life in the entire sample was 30.99 as expressed by the AE-QoL and 0.873 as expressed by the EQ-5D-5L utility value. Utilities dropped by 0.320 points during an angioedema attack. TSQM scores ranged from 66.67 to 75.00 across its 4 domains. On average, total costs per year incurred €22,764, predominantly existing of HAE-medication costs. Total costs showed substantial variation between patients. CONCLUSIONS This study describes the entire burden of HAE among Dutch patients comprising disease control, quality of life, treatment satisfaction, and societal costs. These results can inform cost-effectiveness analyses that can aid reimbursement decisions for HAE treatments.
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Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip C G Klein
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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30
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Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder that usual results from a decreased level of functional C1-INH and clinically manifests with intermittent attacks of swelling of the subcutaneous tissue or submucosal layers of the respiratory or gastrointestinal tracts. Laboratory studies and radiographic imaging have limited roles in evaluation of patients with acute attacks of HAE except when the diagnosis is uncertain and other processes must be ruled out. Treatment begins with assessment of the airway to determine the need for immediate intervention. Emergency physicians should understand the pathophysiology of HAE to help guide management decisions.
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Affiliation(s)
- R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Joseph J Moellman
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB 1654, Cincinnati, OH 45267-0769, USA. https://twitter.com/edmojo
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Farkas H, Balla Z. A safety review of prophylaxis drugs for adolescent patients with hereditary angioedema. Expert Opin Drug Saf 2023; 22:549-561. [PMID: 37334624 DOI: 10.1080/14740338.2023.2226861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/14/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Hereditary angioedema (HAE) is characterized by recurrent subcutaneously and/or submucosally localized edematous swellings. The first symptoms often appear in childhood, and they may become more frequent and severe in puberty. Since the appearance of HAE attacks is unpredictable regarding the localization and the frequency, the attacks put a significant burden on the patients and crucially impacts their quality of life. AREAS COVERED This review article analyzes the safety data acquired from the clinical trials conducted with the currently available medicinal products for the prophylactic treatment of hereditary angioedema due to C1 inhibitor deficiency and the safety data of observatory studies based on clinical practice. A review of the published literature was conducted using the PubMed database, clinical trials from ClinicalTrials.gov, and abstracts published at scientific conferences. EXPERT OPINION The currently available therapeutic products have a good safety and efficiency profile and the international guidelines recommend them as first-line treatments. The choice should be made based on the evaluation of the availability and the preference of the patient.
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Affiliation(s)
- Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- HNO-Praxis Schaffhausen, Schaffhausen, Switzerland
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Bailey M, Linden D, Guo-Parke H, Earley O, Peto T, McAuley DF, Taggart C, Kidney J. Vascular risk factors for COVID-19 ARDS: endothelium, contact-kinin system. Front Med (Lausanne) 2023; 10:1208866. [PMID: 37448794 PMCID: PMC10336249 DOI: 10.3389/fmed.2023.1208866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors, expressed within the lungs. Risk factors for hospitalization include hypertension, diabetes, ischaemic heart disease and obesity-conditions linked by the presence of endothelial pathology. Viral infection in this setting causes increased conversion of circulating Factor XII to its active form (FXIIa). This is the first step in the contact-kinin pathway, leading to synchronous activation of the intrinsic coagulation cascade and the plasma Kallikrein-Kinin system, resulting in clotting and inflammatory lung disease. Temporal trends are evident from blood results of hospitalized patients. In the first week of symptoms the activated partial thromboplastin time (APTT) is prolonged. This can occur when clotting factors are consumed as part of the contact (intrinsic) pathway. Platelet counts initially fall, reflecting their consumption in coagulation. Lymphopenia occurs after approximately 1 week, reflecting the emergence of a lymphocytic pneumonitis [COVID-19 acute respiratory distress syndrome (ARDS)]. Intrinsic coagulation also induces the contact-kinin pathway of inflammation. A major product of this pathway, bradykinin causes oedema with ground glass opacities (GGO) on imaging in early COVID-19. Bradykinin also causes release of the pleiotrophic cytokine IL-6, which causes lymphocyte recruitment. Thromobosis and lymphocytic pneumonitis are hallmark features of COVID-19 ARDS. In this review we examine the literature with particular reference to the contact-kinin pathway. Measurements of platelets, lymphocytes and APTT should be undertaken in severe infections to stratify for risk of developing ARDS.
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Affiliation(s)
- Melanie Bailey
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dermot Linden
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Hong Guo-Parke
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Olivia Earley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tunde Peto
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Danny F. McAuley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Clifford Taggart
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Joseph Kidney
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Watt M, Malmenäs M, Romanus D, Haeussler K. Network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema. J Comp Eff Res 2023; 12:e220188. [PMID: 37218553 PMCID: PMC10402909 DOI: 10.57264/cer-2022-0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Aim: With no head-to-head studies comparing the effectiveness of lanadelumab and berotralstat for prevention of hereditary angioedema (HAE) attacks, this network meta-analysis (NMA) aimed to indirectly compare the effectiveness of these treatments. Materials & methods: The NMA, using the published data from Phase III trials, was performed using a frequentist weighted regression-based approach following Rücker et al. Efficacy outcomes of interest were HAE attack rate per 28 days and ≥90% reduction in monthly HAE attacks. Results & conclusion: In this NMA, lanadelumab 300 mg administered every 2 weeks or every 4 weeks was associated with statistically significantly higher effectiveness versus berotralstat 150 mg once daily (q.d.) or 110 mg q.d. for both efficacy outcomes assessed.
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Affiliation(s)
- Maureen Watt
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Dorothy Romanus
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
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Mendivil J, DerSarkissian M, Banerji A, Diwakar L, Katelaris CH, Keith PK, Kim H, Lacuesta G, Magerl M, Slade C, Smith WB, Choudhry Z, Simon A, Sarda SP, Busse PJ. A multicenter chart review of patient characteristics, treatment, and outcomes in hereditary angioedema: unmet need for more effective long-term prophylaxis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:48. [PMID: 37248521 DOI: 10.1186/s13223-023-00795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, recurring subcutaneous or submucosal swelling. Without effective therapy, HAE can negatively impact patients' quality of life. Management of HAE includes on-demand treatment of attacks and short- and long-term prophylaxis (LTP) to prevent attacks. Newer therapies may be more tolerable and effective in managing HAE; however, therapies such as androgens are still widely used in some countries owing to their relative ease of access and adequate disease control for some patients. This study evaluated the characteristics, treatment patterns, clinical outcomes, and healthcare resource utilization of a multinational cohort of patients with HAE, with a focus on understanding reasons for recommending or discontinuing available therapies. METHODS A retrospective chart review was conducted at 12 centers in six countries and included data from patients with HAE type 1 or 2 who were ≥ 12 years of age at their first clinical visit. The relationship between LTP use and attack rates was evaluated using a multivariable Poisson regression model. Data were collected between March 2018 and July 2019. RESULTS Data from 225 patients were collected (62.7% female, 86.2% White, 90.2% type 1); 64.4% of patients had their first HAE-related visit to the center prior to or during 2014. Treatment patterns varied between countries. Overall, 85.8% of patients were prescribed on-demand treatment and 53.8% were prescribed LTP, most commonly the androgen danazol (53.7% of patients who used LTP). Plasma-derived C1 inhibitor (Cinryze®) was used by 29.8% of patients for LTP. Patients who received LTP had a significantly lower rate of HAE attacks than patients who did not receive any LTP (incidence rate ratio (95% confidence interval) 0.90 (0.84-0.96)). Androgens were the most commonly discontinued therapy (51.3%), with low tolerability cited as the most frequent reason for discontinuation (50.0%). CONCLUSIONS Overall, findings from this study support the use of LTP in the prevention of HAE attacks; a lower rate of attacks was observed with LTP compared with no LTP. However, the type of LTP used varied between countries, with tolerability and accessibility to specific treatments playing important roles in management decision-making.
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Affiliation(s)
- Joan Mendivil
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lavanya Diwakar
- Department of Immunology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | - Harold Kim
- McMaster University, Hamilton, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
| | - Gina Lacuesta
- Halifax Allergy and Asthma Associates, Halifax, NS, Canada
| | - Markus Magerl
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Charlotte Slade
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - William B Smith
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Zia Choudhry
- Takeda Development Center Americas, Lexington, MA, USA
| | - Angela Simon
- Takeda Development Center Americas, Lexington, MA, USA.
| | | | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Honda D, Ohsawa I, Aizawa M, Tomino Y, Asanuma K. Hereditary angioedema with an acute attack resolved after bone marrow transplantation for acute myeloid leukemia: a case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:42. [PMID: 37194078 DOI: 10.1186/s13223-023-00803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE), which is caused by C1-inhibitor (C1-INH) deficiency or dysfunction, is a rare and potentially life-threatening disease. In patients with HAE, excess production of bradykinin causes acute unpredictable recurrent attacks of angioedema in localized regions, including the larynx and intestines. Given the fact that HAE is an autosomal dominant disease, C1-INH produced in patients with HAE is 50% of that produced in healthy individuals. However, most patients with HAE present plasma C1-INH function of < 25% owing to the chronic consumption of C1-INH by kallikrein-kinin, contact, complement, coagulation, and fibrinolysis cascades. Recently, several therapeutic options have been developed for acute attacks and prophylaxis in the treatment of HAE; however, currently, there is no curative therapy for HAE. CASE PRESENTATION Here we report the case of a 48-year-old male patient who presented with a long-standing history of HAE and underwent bone marrow transplantation (BMT) for acute myeloid leukemia (AML) at the age of 39 years and has been in complete remission of AML and HAE thereafter. Notably, after BMT, his C1-INH function gradually increased as follows: < 25%, 29%, 37%, and 45.6%. Since his 20 s, he intermittently presented with an acute attack of HAE once every 3 months from the initial attack. Further, after undergoing BMT, the number of acute attacks decreased to twice within 4 years until the age of 45 years, and subsequently, the patient has been free of acute attacks. C1-INH is mainly synthesized by hepatocytes, but it is known to be partially produced and secreted from peripheral blood monocytes, macrophages, endothelial cells, and fibroblasts. We speculate that the C1-INH function may be increased by extrahepatic production of C1-INH, possibly synthesized by differentiated cells derived from hematopoietic and mesenchymal stem cells after BMT. CONCLUSIONS This case report supports efforts to focus on extrahepatic production of C1-INH in the next strategy of new treatment development for HAE.
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Affiliation(s)
- Daisuke Honda
- Department of Nephrology, Chiba University Hospital, Chiba, Japan
| | - Isao Ohsawa
- Nephrology Unit, Internal Medicine, Saiyu Soka Hospital, Saitama, Japan
| | - Masashi Aizawa
- Department of Nephrology, Chiba University Hospital, Chiba, Japan
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Vanya M, Watt M, Shahraz S, Kosmas CE, Rhoten S, Costa-Cabral S, Menauthoril J, Devercelli G, Weller K. Content validation and psychometric evaluation of the Angioedema Quality of Life Questionnaire for hereditary angioedema. J Patient Rep Outcomes 2023; 7:33. [PMID: 37012445 PMCID: PMC10070575 DOI: 10.1186/s41687-023-00576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is considerable burden of illness in hereditary angioedema (HAE). However, instruments to assess health-related quality of life (HRQoL) in HAE are limited. The Angioedema Quality of Life Questionnaire (AE-QoL) was developed to measure HRQoL in patients with recurrent angioedema; the validity of the AE-QoL in patients with HAE is described. METHODS To identify disease-related experiences with a focus on the impact of HAE on HRQoL, interviews were conducted with a group of clinician experts and patients with HAE from Canada, France, Germany, Spain, the United Kingdom, and the United States, along with a targeted literature review. Concepts were mapped to the AE-QoL to assess item relevance, interpretation, and conceptual coverage. Cognitive interviews assessed item clarity and relevance. A psychometric validation was performed using data from a phase 3 trial. RESULTS Interviews were conducted with seven clinicians and 40 adult patients. Patients reported 35 unique impacts of HAE on their lives, the most frequent being on work/school, social relationships, physical activities, and emotions, particularly fear/worrying and anxiety. Saturation for these impacts was reached, and all concepts covered in the AE-QoL were reported during the interviews. Patients agreed that the questionnaire items and response options were clear and relevant, and the 4-week recall period was appropriate. The psychometric validation included data from 64 patients. For AE-QoL total scores, excellent internal consistency (Cronbach's alpha > 0.90), test-retest reliability (intraclass coefficient > 0.80), convergent validity with the Sheehan Disability Scale (r = 0.663), divergent validity with the EQ-5D-5L index (r = 0.292) and EQ-VAS (r = 0.337), and known-groups validity (p < 0.0001; ɳ2 = 0.56) were demonstrated. CONCLUSIONS Qualitative and psychometric analyses showed that the AE-QoL is a reliable and valid instrument for measuring HRQoL in adult patients with HAE from six countries.
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Affiliation(s)
- Magdalena Vanya
- ICON plc, South San Francisco, CA, USA.
- Takeda Development Center Americas, Inc, Lexington, MA, USA.
| | - Maureen Watt
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Saeid Shahraz
- ICON plc, South San Francisco, CA, USA
- Tufts Medical Center Institute for Clinical Research and Health Policy, Boston, MA, USA
| | | | - Stephanie Rhoten
- ICON plc, South San Francisco, CA, USA
- IQVIA, San Francisco, CA, USA
| | | | | | | | - Karsten Weller
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Javaud N, Gobert D. Hereditary angioedema: is there a better future for treatment? Lancet 2023; 401:1054-1055. [PMID: 36868262 DOI: 10.1016/s0140-6736(23)00438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Nicolas Javaud
- Université Paris Cité, Urgences, AP-HP, Centre de référence des angiœdèmes à kinines, Hôpital Louis Mourier, 92700 Colombes, France.
| | - Delphine Gobert
- Sorbonne Université, Médecine Interne, AP-HP, Centre de référence des angiœdèmes à kinines, Hôpital Saint-Antoine, Paris, France
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Craig TJ, Reshef A, Li HH, Jacobs JS, Bernstein JA, Farkas H, Yang WH, Stroes ESG, Ohsawa I, Tachdjian R, Manning ME, Lumry WR, Saguer IM, Aygören-Pürsün E, Ritchie B, Sussman GL, Anderson J, Kawahata K, Suzuki Y, Staubach P, Treudler R, Feuersenger H, Glassman F, Jacobs I, Magerl M. Efficacy and safety of garadacimab, a factor XIIa inhibitor for hereditary angioedema prevention (VANGUARD): a global, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023; 401:1079-1090. [PMID: 36868261 DOI: 10.1016/s0140-6736(23)00350-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Hereditary angioedema is a rare and potentially life-threatening genetic disease that is associated with kallikrein-kinin system dysregulation. Garadacimab (CSL312), a novel, fully-human monoclonal antibody that inhibits activated factor XII (FXIIa), is being studied for the prevention of hereditary angioedema attacks. The aim of this study was to evaluate the efficacy and safety of once-monthly subcutaneous administrations of garadacimab as prophylaxis for hereditary angioedema. METHODS VANGUARD was a pivotal, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial that recruited patients (aged ≥12 years) with type I or type II hereditary angioedema across seven countries (Canada, Germany, Hungary, Israel, Japan, the Netherlands, and the USA). Eligible patients were randomly assigned (3:2) to receive garadacimab or placebo for 6 months (182 days) by an interactive response technology (IRT) system. Randomisation was stratified by age (≤17 years vs >17 years) and baseline attack rate (1 to <3 attacks per month vs ≥3 attacks per month) for the adult group. The randomisation list and code were kept by the IRT provider during the study, with no access by site staff and funding representatives. All patients and investigational site staff, and representatives from the funder (or their delegates) with direct interaction with the study sites or patients, were masked to treatment assignment in a double-blind fashion. Randomly assigned patients received a 400-mg loading dose of subcutaneous garadacimab as two 200-mg injections or volume-matched placebo on day 1 of the treatment period, followed by five additional self-administered (or caregiver-administered) monthly doses of 200-mg subcutaneous garadacimab or volume-matched placebo. The primary endpoint was the investigator-assessed time-normalised number of hereditary angioedema attacks (number of hereditary angioedema attacks per month) during the 6-month treatment period (day 1 to day 182). Safety was evaluated in patients who received at least one dose of garadacimab or placebo. The study is registered with the EU Clinical Trials Register, 2020-000570-25 and ClinicalTrials.gov, NCT04656418. FINDINGS Between Jan 27, 2021, and June 7, 2022, we screened 80 patients, 76 of whom were eligible to enter the run-in period of the study. Of 65 eligible patients with type I or type II hereditary angioedema, 39 were randomly assigned to garadacimab and 26 to placebo. One patient was randomly assigned in error and did not enter the treatment period (no dose of study drug received), resulting in 39 patients assigned to garadacimab and 25 patients assigned to placebo being included. 38 (59%) of 64 participants were female and 26 (41%) were male. 55 (86%) of 64 participants were White, six (9%) were Asian (Japanese), one (2%) was Black or African American, one (2%) was Native Hawaiian or Other Pacific Islander, and one (2%) was listed as other. During the 6-month treatment period (day 1 to day 182), the mean number of investigator-confirmed hereditary angioedema attacks per month was significantly lower in the garadacimab group (0·27, 95% CI 0·05 to 0·49) than in the placebo group (2·01, 1·44 to 2·57; p<0·0001), corresponding to a percentage difference in means of -87% (95% CI -96 to -58; p<0·0001). The median number of hereditary angioedema attacks per month was 0 (IQR 0·00-0·31) for garadacimab and 1·35 (1·00-3·20) for placebo. The most common treatment-emergent adverse events were upper-respiratory tract infections, nasopharyngitis, and headaches. FXIIa inhibition was not associated with an increased risk of bleeding or thromboembolic events. INTERPRETATION Monthly garadacimab administration significantly reduced hereditary angioedema attacks in patients aged 12 years and older compared with placebo and had a favourable safety profile. Our results support the use of garadacimab as a potential prophylactic therapy for the treatment of hereditary angioedema in adolescents and adults. FUNDING CSL Behring.
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Affiliation(s)
- Timothy J Craig
- Allergy, Asthma and Immunology, Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA.
| | - Avner Reshef
- Allergy, Immunology & Angioedema Center, Barzilai University Hospital, Ashkelon, Israel
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | | | - Jonathan A Bernstein
- University of Cincinnati, Department of Internal Medicine Division of Rheumatology, Allergy and Immunology and the Bernstein Clinical Research Center Cincinnati, Cincinnati, OH, USA
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - William H Yang
- Ottawa Allergy Research Corporation, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Isao Ohsawa
- Department of Nephrology, Saiyu Soka Hospital, Saitama, Japan
| | - Raffi Tachdjian
- Division of Allergy & Clinical Immunology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Michael E Manning
- Allergy, Asthma & Immunology Associates, Ltd, Internal Medicine, UA College of Medicine, Phoenix, Phoenix, AZ, USA
| | | | | | - Emel Aygören-Pürsün
- Klinikum der Johann Wolfgang-Goethe Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gordon L Sussman
- Gordon Sussman Clinical Research Inc and Department of Clinical Immunology and Allergy, St Michael's Hospital, Toronto, ON, Canada
| | | | - Kimito Kawahata
- St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Regina Treudler
- University Leipzig Medical Faculty, Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology-CAC, Leipzig, Germany
| | | | | | | | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Chong-Neto HJ. A narrative review of recent literature of the quality of life in hereditary angioedema patients. World Allergy Organ J 2023; 16:100758. [PMID: 36994443 PMCID: PMC10040818 DOI: 10.1016/j.waojou.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/30/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare disorder that causes unpredictable and debilitating cutaneous and submucosal edema and can lead to death. HAE can impair patients' ability to perform daily activities, proportional to pain severity, with patients reporting lower productivity, missed time from work or school and potentially resulting in missed career and educational opportunities. Many patients with HAE experience a significant psychological burden, including anxiety and depression. Available treatment aims to prevent and/or treat HAE attacks as they occur, to reduce morbidity and mortality and, finally, to improve health-related quality of life. Two different validated specific angioedema instruments are available to assess patients' quality of life. The Angioedema Quality of Life Questionnaire (AE-QoL) examines diagnosed patients' quality of life but is not specific for HAE. The disease-specific questionnaire is the Hereditary Angioedema Quality of Life (HAE-QoL), and the first used for hereditary angioedema with C1 inhibitors (C1-INH) deficiency. These quality-of-life instruments are helpful to the HAE patients' assessment and to the development of better therapeutic strategies as clinical tools, as defined by international guidelines. Considering this context, this review was conducted to compare the effects of acute vs. long-term prophylaxis on HAE patients' health-related quality of life. In addition, the prevalence of anxiety and depression among these individuals was also reviewed.
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40
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Sinnathamby ES, Issa PP, Roberts L, Norwood H, Malone K, Vemulapalli H, Ahmadzadeh S, Cornett EM, Shekoohi S, Kaye AD. Hereditary Angioedema: Diagnosis, Clinical Implications, and Pathophysiology. Adv Ther 2023; 40:814-827. [PMID: 36609679 PMCID: PMC9988798 DOI: 10.1007/s12325-022-02401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
Hereditary angioedema (HAE) is an autosomal dominant disorder caused by a mutation in the C1 esterase inhibitor gene. HAE affects 1/50,000 people worldwide. Three main types of HAE exist: type I, type II, and type III. Type I is characterized by a deficiency in C1-INH. C1-INH is important in the coagulation complement, contact systems, and fibrinolysis. Most HAE cases are type I. Type I and II HAE result from a mutation in the SERPING1 gene, which encodes C1-INH. Formally known as type III HAE is typically an estrogen-dependent or hereditary angioedema with normal C1-INH activity. Current guidelines now recommend subdividing hereditary angioedema with normal C1 esterase inhibitor gene (HAE-nl-C1-INH formerly known as HAE type III) based on underlying mutations such as in kininogen-1 (HAE-KNG1), plasminogen gene (PLG-HAE), myoferlin gene mutation (MYOF-HAE), heparan sulfate-glucosamine 3-sulfotransferase 6 (HS3ST6), mutation in Hageman factor (factor XII), and in angiopoietin-1 (HAE-ANGPT-1). The clinical presentation of HAE varies between patients, but it usually presents with nonpitting angioedema and occasionally abdominal pain. Young children are typically asymptomatic. Those affected by HAE usually present with symptoms in their early 20s. Symptoms can arise as a result of stress, infection, or trauma. Laboratory testing shows abnormal levels of C1-INH and high levels of bradykinin. C4 and D-dimer levels can also be monitored if an acute HAE attack is suspected. Acute treatment of HAE can include IV infusions of C1-INH, receptor antagonists, and kallikrein inhibitors. Short- and long-term prophylaxis can also be administered to patients with HAE. First-line therapies for long-term prophylaxis also include IV infusion of C1-INH. This review aims to thoroughly understand HAE, its clinical presentation, and how to treat it.
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Affiliation(s)
- Evan S Sinnathamby
- School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, 70112, USA.
| | - Peter P Issa
- School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, 70112, USA
| | - Logan Roberts
- School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, 70112, USA
| | - Haley Norwood
- School of Medicine, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Kevin Malone
- School of Medicine, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Harshitha Vemulapalli
- School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, 70112, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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Farkas H, Balla Z. A review of berotralstat for the treatment of hereditary angioedema. Expert Rev Clin Immunol 2023; 19:145-153. [PMID: 36408587 DOI: 10.1080/1744666x.2023.2150611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) imposes a significant disease burden on patients and their families. Unpredictable episodes of angioedema, which can lead to life-threatening conditions, have a significant impact on the quality of life of the patient. The fundamental aim of the treatment of C1-INH-HAE is to ensure that patients can lead a normal life. The most effective way to do this is to prevent the onset of angioedema attacks. AREAS COVERED This review gives a brief overview of the safety and efficacy of the oral kallikrein inhibitor berotralstat in C1-INH-HAE disease. It provides a comprehensive synopsis of the results of the first clinical trials with a targeted oral kallikrein inhibitor (APeX-1 [NCT02870972]; ZENITH-1 [NCT03240133]; APeX-2 [NCT03485911]; APeX-S [NCT03472040]; APeX-J [NCT03873116]), reviewing evidence on the efficacy and safety of the drug, and placing berotralstat on the spectrum of long-term prophylactic therapeutic options. EXPERT OPINION The availability of the first targeted oral prophylactic drug, the kallikrein inhibitor berotralstat, in 2021, is a milestone in the treatment of patients with hereditary angioedema.
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Affiliation(s)
- Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,School of PhD Studies, Semmelweis University, Budapest, Hungary
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Hereditary Angioedema During Pregnancy: Considerations in Management. Immunol Allergy Clin North Am 2023; 43:145-157. [PMID: 36411000 DOI: 10.1016/j.iac.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, hereditary angioedema (HAE) management has substantially advanced but also become more complex with additional therapeutic options. Pregnancy significantly influences the clinical symptoms of HAE in many women because of estrogen effects or other physiologic factors, and also introduces important safety concerns related to HAE medications. Management of HAE during pregnancy requires clinicians to be familiar with the potential clinical course, triggers, and recommended treatment strategies to provide guidance and optimal medical management to women and families affected by the condition. This review provides an overview of data, considerations, and recommendations related to HAE and pregnancy.
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Abstract
Hereditary angioedema is a rare autosomal dominant condition characterized by episodes of swelling of the upper airway, intestines, and skin. The disorder is characterized by deficiency in C1 esterase inhibitor (C1-INH) or a decrease in functional C1-INH. Treatment options include on demand therapy (treatment of acute attacks), long-term prophylaxis, and short-term prophylaxis. Corticosteroids, epinephrine, and antihistamines are not effective for this form of angioedema. The high mortality in patients undiagnosed underscores a need for broader physician awareness to identify these patients and initiate therapy.
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Affiliation(s)
- Arindam Sarkar
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77007, USA.
| | - Crystal Nwagwu
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77007, USA
| | - Timothy Craig
- Pediatrics and Biomedical Sciences, Penn State University, 500 University Drive, Hershey, PA 17033, USA
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Zuraw BL, Maurer M, Sexton DJ, Cicardi M. Therapeutic monoclonal antibodies with a focus on hereditary angioedema. Allergol Int 2023; 72:54-62. [PMID: 35787344 DOI: 10.1016/j.alit.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 01/25/2023] Open
Abstract
Monoclonal antibodies (mAbs) have been shown to be effective and generally safe across a continually expanding list of therapeutic areas. We describe the advantages and limitations of mAbs as a therapeutic option compared with small molecules. Specifically, we discuss a novel mAb in the treatment of hereditary angioedema (HAE), a rare and potentially life-threatening condition characterized by recurrent unpredictable swelling attacks. HAE is mediated by dysregulation of plasma kallikrein activity leading to overproduction of bradykinin. Current prophylactic treatment for HAE includes androgens or replacement of the endogenous plasma kallikrein inhibitor, C1 inhibitor. However, there remains an unmet need for an effective, less burdensome treatment option. Lanadelumab is a fully human mAb targeting plasma kallikrein. Results from clinical trials, including a pivotal Phase 3 study and its ensuing open-label extension study, demonstrated that lanadelumab is associated with few treatment-related adverse events and reduced the rate of HAE attacks. This novel treatment option has the potential to significantly improve the lives of patients with HAE.
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Affiliation(s)
- Bruce L Zuraw
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, CA, USA.
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | - Marco Cicardi
- Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, IRCCS ICS Maugeri, Milano, Italy
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Bridges JM, Chatham WW. Biologic Response Modifiers. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Petkova E, Yordanova V, Staevska M, Valerieva A. Safety Aspects and Rational Use of Lanadelumab Injections in the Treatment of Hereditary Angioedema (HAE): Clinical Insights. Drug Healthc Patient Saf 2022; 14:195-210. [PMID: 36578774 PMCID: PMC9791933 DOI: 10.2147/dhps.s345443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent episodes of skin/mucosal swelling, and/or attacks of severe abdominal pain when it affects the gastrointestinal tract. The disease might be unexpectedly fatal when the upper airways are compromised. HAE clinical presentation, disease course and prognosis are associated with significant disease burden and severely impaired quality of life. Lanadelumab is a breakthrough therapy for the prevention of attacks in HAE type 1 and 2 patients. This revolutionary approach to administer a single subcutaneous injection (once every two to four weeks) and achieve complete disease control has dramatically improved patient care resulting in significant change in the life of affected families. Current data support the drug's tolerability in adult and adolescent patients without notable safety concerns in both clinical research and real-world settings. Rational use of prophylactic treatments of HAE searches for a socio-economic balance, taking into account the life-long course of the disease, the public health funds who pay the monetary price, and the patients who might need to receive the therapy for a period longer than investigated during the development program. In this review, we address the current evidence on lanadelumab's tolerability, highlighting aspects of the drug's rationale use in clinical practice. Further studies need to investigate whether this therapy might be appropriate in other forms of angioedema, such as idiopathic primary angioedema and HAE with normal C1 inhibitor. Future efforts must focus to improve modern drugs' accessibility in more countries. Although modern prophylactic options lessen the risk of fatal laryngeal attacks, patients must be equipped with reliable on-demand therapies and be trained how to use them as such a risk cannot be fully diminished with potentially life-threatening attacks occurring even in subjects with successful and stable long-term prophylaxis. Notwithstanding, further studies are needed to identify early responders from non-responders and develop therapies for the latter.
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Affiliation(s)
- Elena Petkova
- Department of Allergology, Medical University of Sofia, University Hospital “Alexandrovska”, Sofia, Bulgaria
| | - Vanya Yordanova
- Department of Allergology, Medical University of Sofia, University Hospital “Alexandrovska”, Sofia, Bulgaria
| | - Maria Staevska
- Department of Allergology, Medical University of Sofia, University Hospital “Alexandrovska”, Sofia, Bulgaria
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia, University Hospital “Alexandrovska”, Sofia, Bulgaria,Correspondence: Anna Valerieva, Email
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Petersen RS, Fijen LM, Levi M, Cohn DM. Hereditary Angioedema: The Clinical Picture of Excessive Contact Activation. Semin Thromb Hemost 2022. [PMID: 36417927 DOI: 10.1055/s-0042-1758820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hereditary angioedema is a rare, genetic disorder characterized by painful, debilitating and potentially life-threatening angioedema attacks in subcutaneous and submucosal tissue. While usually unpredictable, attacks can be provoked by a variety of triggers including physical injury and certain medication and are often preceded by prodromal symptoms. Hereditary angioedema has a profound influence on the patients' lives. The fundamental cause of hereditary angioedema in almost all patients is a mutation in the SERPING1 gene leading to a deficiency in C1-inhibitor. Subsequently, the contact activation cascade and kallikrein-kinin pathway are insufficiently inhibited, resulting in excessive bradykinin production triggering vascular leakage. While C1-inhibitor is an important regulator of the intrinsic coagulation pathway, fibrinolytic system and complement cascade, patients do not have an increased risk of coagulopathy, autoimmune conditions or immunodeficiency disorders. Hereditary angioedema is diagnosed based on C1-inhibitor level and function. Genetic analysis is only required in rare cases where hereditary angioedema with normal C1-inhibitor is found. In recent years, new, highly specific therapies have greatly improved disease control and angioedema-related quality of life. This article reviews the clinical picture of hereditary angioedema, the underlying pathophysiology, diagnostic process and currently available as well as investigational therapeutic options.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marcel Levi
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
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Beard N, Frese M, Smertina E, Mere P, Katelaris C, Mills K. Interventions for the long-term prevention of hereditary angioedema attacks. Cochrane Database Syst Rev 2022; 11:CD013403. [PMID: 36326435 PMCID: PMC9632406 DOI: 10.1002/14651858.cd013403.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a serious and potentially life-threatening condition that causes acute attacks of swelling, pain and reduced quality of life. People with Type I HAE (approximately 80% of all HAE cases) have insufficient amounts of C1 esterase inhibitor (C1-INH) protein; people with Type II HAE (approximately 20% of all cases) may have normal C1-INH concentrations, but, due to genetic mutations, these do not function properly. A few people, predominantly females, experience HAE despite having normal C1-INH levels and C1-INH function (rare Type III HAE). Several new drugs have been developed to treat acute attacks and prevent recurrence of attacks. There is currently no systematic review and meta-analysis that included all preventive medications for HAE. OBJECTIVES To assess the benefits and harms of interventions for the long-term prevention of HAE attacks in people with Type I, Type II or Type III HAE. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 3 August 2021. SELECTION CRITERIA We included randomised controlled trials in children or adults with HAE that used medications to prevent HAE attacks. The comparators could be placebo or active comparator, or both; approved and experimental drug trials were eligible for inclusion. There were no restrictions on dose, frequency or intensity of treatment. The minimum length of four weeks of treatment was required for inclusion; this criterion excluded the acute treatment of HAE attacks. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. HAE attacks (number of attacks per person, per population) and change in number of HAE attacks; 2. mortality and 3. serious adverse events (e.g. hepatic dysfunction, hepatic toxicity and deleterious changes in blood tests). Our secondary outcomes were 4. quality of life; 5. severity of breakthrough attacks; 6. disability and 7. adverse events (e.g. weight gain, mild psychological changes and body hair). We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified 15 studies (912 participants) that met the inclusion criteria. The studies included people with Type I and II HAE. The studies investigated avoralstat, berotralstat, subcutaneous C1-INH, plasma-derived C1-INH, nanofiltered C1-INH, recombinant human C1-INH, danazol, and lanadelumab for the prevention of HAE attacks. We did not find any studies on the use of tranexamic acid for prevention of HAE attacks. All drugs except avoralstat reduced the number of HAE attacks compared with placebo. For breakthrough attacks that occurred despite prophylactic treatment, intravenous and subcutaneous forms of C1-INH and lanadelumab reduced attack severity. It is not known whether other drugs have a similar effect, as the severity of breakthrough attacks in people taking drugs other than C1-INH and lanadelumab was not reported. For quality of life, avoralstat, berotralstat, C1-INH (all forms) and lanadelumab increased quality of life compared with placebo; there were no data for danazol. Four studies reported on changes in disability during treatment with C1-INH, berotralstat and lanadelumab; all three drugs decreased disability compared with placebo. Adverse events, including serious adverse events, did not occur at a rate higher than placebo. However, serious adverse event data and other adverse event data were not available for danazol, which prevented us from drawing conclusions about the absolute or relative safety of this drug. No deaths were reported in the included studies. The analysis was limited by the small number of studies, the small number of participants in each study and the lack of data on older drugs, therefore the certainty of the evidence is low. Given the rarity of HAE, it is not surprising that drugs were rarely directly compared, which does not allow conclusions on the comparative efficacy of the various drugs for people with HAE. Finally, we did not identify any studies that included people with Type III HAE. Therefore, we cannot draw any conclusions about the efficacy or safety of any drug in people with this form of HAE. AUTHORS' CONCLUSIONS The available data suggest that berotralstat, C1-INH (subcutaneous, plasma-derived, nanofiltered and recombinant), danazol and lanadelumab are effective in lowering the risk or incidence (or both) of HAE attacks. In addition, C1-INH and lanadelumab decrease the severity of breakthrough attacks (data for other drugs were not available). Avoralstat, berotralstat, C1-INH (all forms) and lanadelumab increase quality of life and do not increase the risk of adverse events, including serious adverse events. It is possible that danazol, subcutaneous C1-INH and recombinant human C1-INH are more effective than berotralstat and lanadelumab in reducing the risk of breakthrough attacks, but the small number of studies and the small size of the studies means that the certainty of the evidence is low. This and the lack of head-to-head trials prevented us from drawing firm conclusions on the relative efficacy of the drugs.
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Affiliation(s)
- Nicole Beard
- Faculty of Science and Technology, University of Canberra, Bruce, Australia
| | - Michael Frese
- Faculty of Science and Technology, University of Canberra, Bruce, Australia
| | - Elena Smertina
- Faculty of Science and Technology, University of Canberra, Bruce, Australia
| | - Peter Mere
- Department of Mathematics and Statistics, Macquarie University, Macquarie Park, Australia
| | - Constance Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University, Campbelltown, Australia
| | - Kerry Mills
- Faculty of Science and Technology, University of Canberra, Bruce, Australia
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Guo Y, Zhang H, Lai H, Wang H, Chong-Neto HJ, Valle SOR, Zhu R. Long-term Prophylaxis with Androgens in the management of Hereditary Angioedema (HAE) in emerging countries. Orphanet J Rare Dis 2022; 17:399. [PMID: 36324138 PMCID: PMC9632066 DOI: 10.1186/s13023-022-02536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant genetic disease characterized by repetitive subcutaneous or submucosal angioedema, activation of the kinin system, and increased vascular permeability. C1-inhibitor (C1-INH) deficiency, the main mechanism of HAE pathogenesis, occurs when abnormal activation of plasma kallikrein, bradykinin, and factor XII, or mutation of genes such as SERPING1 cause quantitative or functional C1-INH defects. Although androgens are not approved for HAE treatment in many countries, they are widely used in China and Brazil to reduce the frequency and severity of HAE attacks. The long-term adverse effects of androgen treatment are concerning for both physicians and patients. Virilization, weight gain, acne, hirsutism, liver damage, headache, myalgia, hematuria, menstrual disorders, diminished libido, arterial hypertension, dyslipidemia, and anxiety/depression are commonly observed during long-term treatment with androgens. These adverse effects can affect the quality of life of HAE patients and often lead to treatment interruption, especially in women and children. In-depth studies of the pathogenesis of HAE have led to the approval of alternative treatment strategies, including plasma-derived C1 inhibitor, recombinant human C1 inhibitor, plasma Kallikrein inhibitor (ecallantide; lanadelumab), and bradykinin B2 receptor antagonist (icatibant), some of which have achieved satisfactory results with mostly non-serious side effects. Therefore, a new standard of medical care may expand possibilities for the management of HAE in emerging countries.
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Affiliation(s)
- Yinshi Guo
- grid.16821.3c0000 0004 0368 8293Department of Allergy and Immunology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huanping Zhang
- grid.470966.aDepartment of Allergy Medicine, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - He Lai
- grid.412534.5Department of Allergy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huiying Wang
- grid.13402.340000 0004 1759 700XDepartment of Allergy, The Second Affiliated Hospital,, Zhejiang University School of Medicine, Hangzhou, China
| | - Herberto J. Chong-Neto
- grid.20736.300000 0001 1941 472XDepartment of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Solange O. R. Valle
- grid.8536.80000 0001 2294 473XDepartment of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rongfei Zhu
- grid.33199.310000 0004 0368 7223Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
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Craig TJ, Zaragoza-Urdaz RH, Li HH, Yu M, Ren H, Juethner S, Anderson J. Effectiveness and safety of lanadelumab in ethnic and racial minority subgroups of patients with hereditary angioedema: results from phase 3 studies. ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY 2022; 18:85. [PMID: 36153561 PMCID: PMC9508782 DOI: 10.1186/s13223-022-00721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic has highlighted disparities in healthcare, particularly in the United States, even though disparities have existed since the organization of the modern healthcare system. Recruitment of patients from racial and ethnic minority groups is often minimal in phase 3 clinical trials, and is further exacerbated in the case of trials for rare diseases such as hereditary angioedema (HAE). This can lead to a gap in the understanding of minority patients’ experiences with these diseases and their response to potential treatment options. Methods We reviewed data from phase 3 double-blind (HELP) and open-label extension (HELP OLE) trials of lanadelumab, a monoclonal antibody developed for long-term prophylaxis against attacks of HAE. Efficacy (attack rate reduction) and safety (adverse events) results from White patients were compared descriptively to those from Hispanic/Latino patients, Black/African Americans, and other minority Americans. Results Not surprisingly, few minorities were recruited across both studies: 9.5% Black, 2.4% Asian, and 7.1% Hispanic/Latino versus 88.1% White and 91.7% non-Hispanic/non-Latino received lanadelumab in HELP, and 4.7% Black, 0.9% Asian, 0.9% other, and 6.1% Hispanic/Latino versus 93.4% White and 93.4% non-Hispanic/non-Latino were enrolled in HELP OLE. Although these studies were conducted in the United States, Canada, Europe, and Jordan, all minorities were from the United States. Despite the number of minority patients being far less than expected for the population, there was no evidence that either efficacy or adverse event profiles differed between ethnic or racial groups. Conclusions The HELP and HELP OLE studies described herein recruited far fewer minorities than would be ideal to represent these populations. However, evidence suggests that the effectiveness and tolerance of lanadelumab are similar between the groups. Nonetheless, the disparity in recruitment into research for minorities has significant room for improvement. Trial registration NCT02586805, registered 26 October 2015, https://clinicaltrials.gov/ct2/show/record/NCT02586805. NCT02741596, registered 18 April 2016, https://clinicaltrials.gov/ct2/show/NCT02741596.
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