1
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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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2
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Maurer M, Magerl M, Aygören-Pürsün E, Bork K, Farkas H, Longhurst H, Kiani-Alikhan S, Bouillet L, Boccon-Gibod I, Cancian M, Zanichelli A, Launay D. Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:4. [PMID: 35027083 PMCID: PMC8759255 DOI: 10.1186/s13223-021-00644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00644-0.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany.
| | - Markus Magerl
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany
| | | | - Konrad Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | - Henriette Farkas
- Hungarian Angioedema Center of Excellence and Reference (ACARE), Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Hilary Longhurst
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | - Sorena Kiani-Alikhan
- Angioedema Center of Reference and Excellence (ACARE), Barts Health NHS Trust, London, UK
| | - Laurence Bouillet
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Boccon-Gibod
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Mauro Cancian
- Italian Network for Hereditary and Acquired Angioedema (ITACA), Interregional Center of Reference for Angioedema, University of Padova, Padova, Italy
| | - Andrea Zanichelli
- Italian National Center of Reference for Angiodema, Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco - Università degli Studi di Milano, Milan, Italy
| | - David Launay
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, French National Center of Reference for Angioedema, 59000, Lille, France
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3
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A novel murine in vivo model for acute hereditary angioedema attacks. Sci Rep 2021; 11:15924. [PMID: 34354123 PMCID: PMC8342443 DOI: 10.1038/s41598-021-95125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
Hereditary Angioedema (HAE) is a rare genetic disease generally caused by deficiency or mutations in the C1-inhibitor gene, SERPING1, a member of the Serpin family. HAE results in acute attacks of edema, vasodilation, GI pain and hypotension. C1INH is a key inhibitor of enzymes controlling complement activation, fibrinolysis and the contact system. In HAE patients, contact system activation leads to uncontrolled production of bradykinin, the vasodilator responsible for the characteristic symptoms of HAE. In this study, we present the first physiological in vivo model to mimic acute HAE attacks. We evaluate hypotension, one of the many hallmark symptoms of acute HAE attacks using Serping1 deficient mice (serping1−/−) and implanted telemetry. Attacks were induced by IV injection of a silica nanoparticle (SiNP) suspension. Blood pressure was measured in real time, in conscious and untethered mice using implanted telemetry. SiNP injection induced a rapid, reversible decrease in blood pressure, in the presence of angiotensin converting enzyme (ACE) inhibition. We also demonstrate that an HAE therapeutic, ecallantide, can prevent HAE attacks in this model. The in vivo murine model described here can facilitate the understanding of acute HAE attacks, support drug development and ultimately contribute to improved patient care.
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Iaboni A, Kanani A, Lacuesta G, Song C, Kan M, Betschel SD. Impact of lanadelumab in hereditary angioedema: a case series of 12 patients in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2021; 17:78. [PMID: 34301329 PMCID: PMC8306280 DOI: 10.1186/s13223-021-00579-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/13/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare autosomal dominant disease resulting in recurring episodes of swelling, leading to considerable patient morbidity and mortality. Lanadelumab is a plasma kallikrein inhibitor that is approved as 1st line therapy in Canada for long term prophylaxis of HAE attacks. OBJECTIVE To describe our clinical findings from a case series of adult patients with HAE type 1/2 who have been initiated on lanadelumab. METHODS A chart review of HAE type 1/2 patients at three academic centers in Canada was undertaken with demographic and clinical data extracted. Patients were included if they had been receiving lanadelumab for at least 6 months. Patients with other causes of angioedema were excluded. RESULTS 12 patients meeting enrollment criteria were identified. Compared to pre-lanadelumab, patients had mean reductions of 72% and 62% in attack rate and treated attack rate respectively. 3 patients reported complete remission from attacks after starting lanadelumab. Most patients had significant improvements in HAE impact on social outings. CONCLUSION Our case series findings support the 2019 International/Canadian HAE guideline that lanadelumab is an effective therapy for long term prophylaxis. In our patient population, initiation of lanadelumab improved disease control, minimized the burden of treatment and improved HAE impact on social outings.
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Affiliation(s)
- Aled Iaboni
- Allergy/Immunology Fellow, Department of Internal Medicine, Division of Clinical Immunology and Allergy, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gina Lacuesta
- Department of Medicine, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Christine Song
- Department of Medicine, Division of Allergy and Immunology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Manstein Kan
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen D Betschel
- Medicine and Departmental Division Director for Clinical Immunology and Allergy, Division of Clinical Immunology and Allergy, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
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Riedl MA, Maurer M, Bernstein JA, Banerji A, Longhurst HJ, Li HH, Lu P, Hao J, Juethner S, Lumry WR, Hébert J, Ritchie B, Sussman G, Yang WH, Escuriola Ettingshausen C, Magerl M, Martinez‐Saguer I, Maurer M, Staubach P, Zimmer S, Cicardi M, Perego F, Wu MA, Zanichelli A, Al‐Ghazawi A, Shennak M, Zaragoza‐Urdaz RH, Ghurye R, Longhurst HJ, Zinser E, Anderson J, Banerji A, Baptist AP, Bernstein JA, Boggs PB, Busse PJ, Christiansen S, Craig T, Davis‐Lorton M, Gierer S, Gower RG, Harris D, Hong DI, Jacobs J, Johnston DT, Levitch ES, Li HH, Lockey RF, Lugar P, Lumry WR, Manning ME, McNeil DL, Melamed I, Mostofi T, Nickel T, Otto WR, Petrov AA, Poarch K, Radojicic C, Rehman SM, Riedl MA, Schwartz LB, Shapiro R, Sher E, Smith AM, Smith TD, Soteres D, Tachdjian R, Wedner HJ, Weinstein ME, Zafra H, Zuraw BL. Lanadelumab demonstrates rapid and sustained prevention of hereditary angioedema attacks. Allergy 2020; 75:2879-2887. [PMID: 32452549 PMCID: PMC7689768 DOI: 10.1111/all.14416] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
Background Lanadelumab demonstrated efficacy in preventing hereditary angioedema (HAE) attacks in the phase 3 HELP Study. Objective To assess time to onset of effect and long‐term efficacy of lanadelumab, based on exploratory findings from the HELP Study. Methods Eligible patients with HAE type I/II received lanadelumab 150 mg every 4 weeks (q4wks), 300 mg q4wks, 300 mg q2wks, or placebo. Ad hoc analyses evaluated day 0‐69 findings using a Poisson regression model accounting for overdispersion. Least‐squares mean monthly HAE attack rate for lanadelumab was compared with placebo. Intrapatient comparisons for days 0‐69 versus steady state (days 70‐182) used a paired t test for continuous endpoints or Kappa statistics for categorical endpoints. Results One hundred twenty‐five patients were randomized and treated. During days 0‐69, mean monthly attack rate was significantly lower with lanadelumab (0.41‐0.76) vs placebo (2.04), including attacks requiring acute treatment (0.33‐0.61 vs 1.66) and moderate/severe attacks (0.31‐0.48 vs 1.33, all P ≤ .001). More patients receiving lanadelumab vs placebo were attack free (37.9%‐48.1% vs 7.3%) and responders (85.7%‐100% vs 26.8%). During steady state, the efficacy of lanadelumab vs placebo was similar or improved vs days 0‐69. Intrapatient differences were significant with lanadelumab 300 mg q4wks for select outcomes. Lanadelumab efficacy was durable—HAE attack rate was consistently lower vs placebo, from the first 2 weeks of treatment through study end. Treatment emergent adverse events were comparable during days 0‐69 and 70‐182. Conclusion Protection with lanadelumab started from the first dose and continued throughout the entire study period.
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Affiliation(s)
- Marc A. Riedl
- Division of Rheumatology, Allergy and Immunology University of California, San Diego San Diego CA USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section Department of Internal Medicine University of Cincinnati Cincinnati OH USA
- Bernstein Clinical Research Center Cincinnati OH USA
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - Hilary J. Longhurst
- Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge and University College London Hospitals London UK
| | - H. Henry Li
- Institute for Asthma and Allergy, P.C. Chevy Chase MD USA
| | - Peng Lu
- Shire, a Takeda company Lexington MA USA
| | - James Hao
- Shire, a Takeda company Lexington MA USA
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6
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Li HH, Zuraw B, Longhurst HJ, Cicardi M, Bork K, Baker J, Lumry W, Bernstein J, Manning M, Levy D, Riedl MA, Feuersenger H, Prusty S, Pragst I, Machnig T, Craig T. Subcutaneous C1 inhibitor for prevention of attacks of hereditary angioedema: additional outcomes and subgroup analysis of a placebo-controlled randomized study. Allergy Asthma Clin Immunol 2019; 15:49. [PMID: 31485239 PMCID: PMC6714075 DOI: 10.1186/s13223-019-0362-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hereditary angioedema (HAE) is a debilitating disorder resulting from C1-esterase inhibitor (C1-INH) deficiency. In the COMPACT phase 3 study the prophylactic use of a subcutaneous C1 inhibitor (C1-INH [SC], HAEGARDA®, CSL Behring) twice weekly significantly reduced the frequency of acute edema attacks. Analysis of treatment effects by subgroups, onset of effect, and other exploratory analysis have not been reported. Methods This is a post hoc exploratory analysis on data from the randomized, placebo-controlled COMPACT study. 90 patients with C1-INH-HAE were randomized to 1 of 4 treatment sequences: C1-INH (SC) 40 or 60 IU/kg of body weight twice weekly for 16 weeks, preceded or followed by a placebo period. The pre-specified primary efficacy endpoint was the time-normalized number of HAE attacks, and pre-specified secondary efficacy endpoints were the percentage of patients with a certain treatment response (≥ 50% reduction on C1-INH (SC) versus placebo in the time-normalized number of attacks) and the time-normalized number of use of rescue medication. Pre-specified exploratory endpoints included severity of attacks, alone and combined with rescue medication use. Post hoc analyses included exploration of onset of effect and clinical assessment of patients with < 50% of response. Results Subgroup findings by various patient characteristics showed a consistent preventive effect of C1-INH (SC). In a post hoc analysis of attacks, the onset of the preventive effect within the first 2 weeks after treatment initiation in COMPACT showed that 10/43 patients (23%) experienced attacks of any severity with 60 IU/kg versus 34/42 patients (81%) with placebo. The need for rescue medication was tenfold lower with 60 IU/kg (35 treated attacks) versus placebo (358 treated attacks). A qualitative analysis of the 4 patients treated with 60 IU/kg and with < 50% reduction of attacks demonstrated a reduction in severity of attacks, rescue medication use, and symptom days which was considered a clinically meaningful treatment effect. Conclusions C1-INH (SC) prophylaxis demonstrated a preventive treatment effect with evidence of benefit within 2 weeks. A consistent treatment effect at recommended C1-INH (SC) dosing was evident in all subgroups of patients with type I/II HAE and by various measures of disease and treatment burden. Trial registration EU Clinical Trials Register, 2013-000916-10, Registered 10 December 2013, https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-000916-10; ClinicalTrials.gov Register, NCT01912456, Registered 31 July 2013, https://clinicaltrials.gov/ct2/show/NCT01912456.
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Affiliation(s)
- H Henry Li
- 1Institute for Asthma and Allergy, 2 Wisconsin Cir #250, Chevy Chase, MD 20815 USA
| | - Bruce Zuraw
- 2UC San Diego School of Medicine, 9500 Gilman Dr., Mail code 0732, La Jolla, CA 92093-0732 USA
| | | | - Marco Cicardi
- Ospedale Luigi Sacco/U.O. Medina Generale, Via G.B. Grassi, 74, 20157 Milan, Italy
| | - Konrad Bork
- 5Department of Dermatology, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - James Baker
- Baker Allergy, Asthma & Dermatology Research Center, LLC, 9495 SW Locust, Portland, OR 97223 USA
| | - William Lumry
- AARA Research Center, 10100 N Central Expressway, Suite 125, Dallas, TX 75231 USA
| | - Jonathan Bernstein
- 8Bernstein Clinical Research Center, LLC, 8444 Winton Road, Cincinnati, OH 45231 USA
| | - Michael Manning
- Medical Research of Arizona, 7514 E Monterey Way, Suite-1A, Scottsdale, AZ 85251 USA
| | - Donald Levy
- 705 West La Veta Avenue, Suite 101, Orange, CA 92868 USA
| | - Marc A Riedl
- 11University of California-San Diego School of Medicine, 8899 University Center Lane, Suite 230, La Jolla, CA 92122 USA
| | | | | | | | | | - Timothy Craig
- 13Department of Medicine and Pediatrics, Penn State University Allergy, Immunology and Respiratory Research, 500 University Drive H041, Hershey, PA 17033 USA
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Qiu T, Chiuchiolo MJ, Whaley AS, Russo AR, Sondhi D, Kaminsky SM, Crystal RG, Pagovich OE. Gene therapy for C1 esterase inhibitor deficiency in a Murine Model of Hereditary angioedema. Allergy 2019; 74:1081-1089. [PMID: 30059156 DOI: 10.1111/all.13582] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a life-threatening, autosomal dominant disorder characterized by unpredictable, episodic swelling of the face, upper airway, oropharynx, extremities, genitalia, and gastrointestinal tract. Almost all cases of HAE are caused by mutations in the SERPING1 gene resulting in a deficiency in functional plasma C1 esterase inhibitor (C1EI), a serine protease inhibitor that normally inhibits proteases in the contact, complement, and fibrinolytic systems. Current treatment of HAE includes long-term prophylaxis with attenuated androgens or human plasma-derived C1EI and management of acute attacks with human plasma-derived or recombinant C1EI, bradykinin, and kallikrein inhibitors, each of which requires repeated administration. As an approach to effectively treat HAE with a single treatment, we hypothesized that a one-time intravenous administration of an adeno-associated virus (AAV) gene transfer vector expressing the genetic sequence of the normal human C1 esterase inhibitor (AAVrh.10hC1EI) would provide sustained circulating C1EI levels sufficient to prevent angioedema episodes. METHODS To study the efficacy of AAVrh.10hC1EI, we used CRISPR/Cas9 technology to create a heterozygote C1EI-deficient mouse model (S63±) that shares characteristics associated with HAE in humans including decreased plasma C1EI and C4 levels. Phenotypically, these mice have increased vascular permeability of skin and internal organs. RESULTS Systemic administration of AAVrh.10hC1EI to the S63± mice resulted in sustained human C1EI activity levels above the predicted therapeutic levels and correction of the vascular leak in skin and internal organs. CONCLUSION A single treatment with AAVrh.10hC1EI has the potential to provide long-term protection from angioedema attacks in affected individuals.
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Affiliation(s)
- Ting Qiu
- Department of Genetic Medicine Weill Cornell Medical College New York New York
- Department of Respiratory Medicine KunShan Hospital of Traditional Chinese Medicine Kunshan China
| | - Maria J. Chiuchiolo
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Adele S. Whaley
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Anthony R. Russo
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Dolan Sondhi
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Stephen M. Kaminsky
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Ronald G. Crystal
- Department of Genetic Medicine Weill Cornell Medical College New York New York
| | - Odelya E. Pagovich
- Department of Genetic Medicine Weill Cornell Medical College New York New York
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8
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Busse PJ, Farkas H, Banerji A, Lumry WR, Longhurst HJ, Sexton DJ, Riedl MA. Lanadelumab for the Prophylactic Treatment of Hereditary Angioedema with C1 Inhibitor Deficiency: A Review of Preclinical and Phase I Studies. BioDrugs 2019; 33:33-43. [PMID: 30539362 PMCID: PMC6373397 DOI: 10.1007/s40259-018-0325-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hereditary angioedema (HAE) with C1 esterase inhibitor (C1-INH) deficiency (C1-INH-HAE) is a rare disease characterized by diminished levels or dysfunctional activity of C1-INH, leading to dysregulated plasma kallikrein activity within the kallikrein-kinin pathway. Symptoms manifest as painful, potentially life-threatening swelling of subcutaneous tissues throughout the body and/or submucosal edema in the upper airway or gastrointestinal tract. Attacks recur with unpredictable frequency, intensity, and duration, placing a heavy burden on patients' daily lives. Despite improved availability of medications for on-demand treatment during attacks and prophylaxis of future attacks, unmet needs remain. Lanadelumab, a fully human monoclonal antibody, may help address some of the limitations of existing prophylactic options (e.g., the need for intravenous administration or frequent dosing). Preclinical studies demonstrate that it is highly potent and specifically inhibits plasma kallikrein, and findings from phase Ia and Ib studies suggest this agent is well tolerated and provides sustained inhibition of plasma kallikrein, allowing for less frequent dosing. The phase III HELP Study (NCT02586805) evaluating the efficacy and safety of lanadelumab in preventing HAE attacks has been completed, and its open-label extension (NCT02741596) is ongoing. Lanadelumab is now approved in the USA and Canada for prophylaxis to prevent attacks of HAE in patients aged ≥ 12 years. This review provides an overview of the discovery and clinical development of lanadelumab, from preclinical through phase Ib studies, characterizing its safety/tolerability, efficacy, and pharmacokinetic and pharmacodynamic profiles. It also highlights how this agent may positively impact clinical care of patients with C1-INH-HAE.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Angioedemas, Hereditary/drug therapy
- Angioedemas, Hereditary/pathology
- Angioedemas, Hereditary/physiopathology
- Angioedemas, Hereditary/prevention & control
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Clinical Trials, Phase I as Topic
- Drug Evaluation, Preclinical
- Humans
- Middle Aged
- Plasma Kallikrein/antagonists & inhibitors
- Plasma Kallikrein/drug effects
- Young Adult
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Affiliation(s)
- Paula J Busse
- Division of Clinical Immunology and Allergy, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room 11-20, New York, NY, 10029, USA.
| | - Henriette Farkas
- Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, Budapest, 1125, Hungary
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Cox 201, Boston, MA, 02114, USA
| | - William R Lumry
- Allergy and Asthma Research Associates, 10100 N. Central Expressway, Suite 100, Dallas, TX, 75231, USA
| | - Hilary J Longhurst
- Department of Immunology, Addenbrookes Hospital Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | | | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, 8899 University Center Lane, Suite 230, San Diego, CA, 92122, USA
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9
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Akoglu G, Kesim B, Yildiz G, Metin A. Outcomes of long term treatments of type I hereditary angioedema in a Turkish family. An Bras Dermatol 2018; 92:655-660. [PMID: 29166502 PMCID: PMC5674698 DOI: 10.1590/abd1806-4841.20175899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
Background Hereditary angioedema is a rare autosomal dominantly inherited
immunodeficiency disorder characterized by potentially life-threatening
angioedema attacks. Objective We aimed to investigate the clinical and genetic features of a family with
angioedema attacks. Methods The medical history, clinical features and C1-INH gene mutation of a Turkish
family were investigated and outcomes of long-term treatments were
described. Results Five members had experienced recurrent swellings on the face and extremities
triggered by trauma. They were all misdiagnosed as familial Mediterranean
fever (FMF) depending on frequent abdominal pain and were on colchicine
therapy for a long time. They had low C4 and C1-INH protein concentrations
and functions. A mutation (c.1247T>A) in C1-INH gene was detected. They
were diagnosed as having hereditary angioedema with C1-INH deficiency
(C1-INH hereditary angioedema) for the first time. Three of them benefited
from danazol treatment without any significant adverse events and one
received weekly C1 esterase replacement treatment instead of danazol since
she had a medical history of thromboembolic stroke. Study limitations Small sample size of participants. Conclusion Patients with C1-INH hereditary angioedema may be misdiagnosed as having
familial Mediterranean fever in regions where the disorder is endemic.
Medical history, suspicion of hereditary angioedema and laboratory
evaluations of patients and their family members lead the correct diagnoses
of hereditary angioedema. Danazol and C1 replacement treatments provide
significant reduction in hereditary angioedema attacks.
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Affiliation(s)
- Gulsen Akoglu
- Dermatovenereology Clinic, Ataturk Training and Research Hospital - Ankara, Turkey
| | - Belgin Kesim
- Medical Genetics, Sisli Hamidiye Etfal Training and Research Hospital - Istanbul, Turkey
| | - Gokhan Yildiz
- Medical Biology, Faculty of Medicine, Erzincan University- Erzincan, Turkey
| | - Ahmet Metin
- Dermatovenereology Clinic, Ataturk Training and Research Hospital - Ankara, Turkey
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Abstract
PURPOSE OF REVIEW The aims of this study are to update the clinician on current understanding of angioedema as it presents in the pediatric population and to review proper diagnostic techniques and treatment modalities for various types of angioedema. RECENT FINDINGS Angioedema is still best classified by whether it is likely histaminergic or kinin-mediated. New guidelines have been published around the world to help diagnose and treat both forms (urticaria/angioedema and hereditary angioedema). The vast majority of the studies on treatment have been conducted in the adult population; however, there are data available in the pediatric population. In the realm of hereditary angioedema, there are multiple new therapies that have been studied in the pediatric population (down to 2 years in some studies) in recent years and offer the clinician options for treatment. Angioedema (whether occurring with or without urticaria) is common in the pediatric population. The majority of the recent studies has been conducted in hereditary angioedema, and now, the clinician should have various options to treat all forms of angioedema. Many treatment options, especially for hereditary angioedema, are further being examined specifically in the pediatric population.
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Affiliation(s)
- Debendra Pattanaik
- Department of Internal Medicine, Division of Rheumatology, The University of Tennessee Health Science Center, 51 North Dunlap, Suite 400, Memphis, TN, 38105, USA
| | - Jay Adam Lieberman
- Department of Pediatrics, Division of Allergy & Immunology, The University of Tennessee Health Science Center, 51 North Dunlap, Suite 400, Memphis, TN, 38105, USA.
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