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Honda D, Li PH, Jindal AK, Katelaris CH, Zhi YX, Thong BYH, Longhurst HJ. Uncovering the true burden of hereditary angioedema due to C1-inhibitor deficiency: A focus on the Asia-Pacific region. J Allergy Clin Immunol 2024; 153:42-54. [PMID: 37898409 DOI: 10.1016/j.jaci.2023.09.039] [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: 06/28/2023] [Revised: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023]
Abstract
Hereditary angioedema (HAE) due to C1-inhibitor deficiency or dysfunction is a rare genetic disorder that causes recurrent episodes of swelling in various parts of the body. Treatment goals of HAE aim to "normalize" life for all patients; however, lack of diagnostic facilities and limited access to effective treatment options in developing nations cause delays in diagnosis and place a significant burden on patients. In this review, we aim to highlight the burden of disease caused by C1-inhibitor HAE across the Asia-Pacific region, considering its epidemiology, morbidity and mortality, and socioeconomic and psychological impact. We also review the availability of guideline-recommended diagnostic facilities and treatments, and how patients are currently managed. Data were collected from published literature and HAE experts in the region, who provided information regarding diagnosis and management in their countries. Current practice was reviewed against international guidelines, as well as local guidelines/consensus used in Australia, Japan, and China. Suggestions are provided for improving the time to diagnosis in the region, increasing access to guideline-recommended treatments, and providing support to reduce the burden on patients and caregivers. There is an urgent need to improve HAE services and provide access to life-saving treatment in developing countries, and efforts should be made to increase awareness of guideline recommendations in high-income economies that do not currently provide long-term prophylactic treatments.
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Affiliation(s)
- Daisuke Honda
- Department of Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ankur Kumar Jindal
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Constance H Katelaris
- Immunology and Allergy Unit, Department of Medicine, Campbelltown Hospital and Western Sydney University, Campbelltown, Sydney, Australia
| | - Yu-Xiang Zhi
- Department of Allergy and Clinical Immunology, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Hilary J Longhurst
- Department of Immunology, Auckland City Hospital, Grafton, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
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Efficacy, pharmacokinetics, and safety of subcutaneous C1-esterase inhibitor as prophylaxis in Japanese patients with hereditary angioedema: Results of a Phase 3 study. Allergol Int 2023:S1323-8930(23)00006-0. [PMID: 36858856 DOI: 10.1016/j.alit.2023.02.002] [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: 11/01/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare and potentially life-threatening genetic disorder characterized by recurrent attacks of angioedema. HAE types I and II result from deficient or dysfunctional C1-esterase inhibitor (C1-INH). This Phase 3 study assessed the efficacy, pharmacokinetics (PK), and safety of subcutaneous (SC) C1-INH in Japanese patients with HAE. METHODS The prospective, open-label, multicenter, single-arm Phase 3 study recruited patients with HAE types I or II to an initial run-in period, followed by a 16-week treatment period where patients received 60 IU/kg C1-INH (SC) twice weekly. The two primary endpoints were the time-normalized number of HAE attacks per month and C1-INH functional activity at Week 16. RESULTS Nine patients entered the treatment period and completed the study. Treatment with C1-INH (SC) significantly reduced the mean monthly attack rate from 3.7 during the run-in period to 0.3 during treatment (exploratory p value of within-patient comparison = 0.004). After the last dose of C1-INH (SC) at Week 16, the mean trough concentration of C1-INH was 59.8%, and the mean area under the plasma concentration-time curve to the end of the dosing period and to the last sample were 5317.1 and 13,091.5 h•%, respectively. During the study, there were no deaths, serious adverse events, or adverse events leading to study discontinuation. CONCLUSIONS C1-INH (SC) (60 IU/kg twice weekly) was efficacious and well tolerated as a prophylaxis against HAE attacks in Japanese patients with HAE types I or II, which was supported by the increased and maintained C1-INH functional activity. EudraCT Number 2019-003921-99; JapicCTI-205273.
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Wong JC, Chiang V, Lam K, Tung E, Au EY, Lau CS, Li PH. Prospective Study on the Efficacy and Impact of Cascade Screening and Evaluation of Hereditary Angioedema (CaSE-HAE). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2896-2903.e2. [PMID: 35964924 DOI: 10.1016/j.jaip.2022.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 07/30/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Recommendations regarding family screening for hereditary angioedema (HAE) remain variable and mostly based on expert opinion. Studies evaluating its implementation and efficacy are lacking. OBJECTIVES A novel HAE screening program was established to evaluate the efficacy and impact of cascade family screening (CFS) for at-risk relatives. METHODS Potential HAE relatives were screened through the CFS approach. Prospective data on clinical, psychological, and HAE-related outcomes were collected at baseline and 1-year follow-up. Longitudinal outcomes were analyzed and compared between index patients and those given a diagnosis through CFS. RESULTS Of 179 relatives, 53% were contactable, 67% of whom consented to screening. Twenty-nine patients (46%) were newly given the diagnosis of HAE; half were symptomatic at baseline (52%). There was a stronger trend toward higher diagnostic yield among first-degree families, although this did not meet statistical significance (57.6% vs 33.3%; P = .077). Among symptomatic patients, there was a higher proportion with complete annual HAE remission (15% vs 46%; P = .021) and a reduction in annual HAE-related hospital admissions (1 vs 0; P = .016) and length of stay (3 vs 2 days; P = .001) after 1 year. Among all patients, there were reduced Hospital Anxiety and Depression Scale-anxiety (14.35 ± 6.32 vs 6.47 ± 4.14; P = .001) and improved Angioedema Quality of Life scores (55% vs 35%; P < .001). By extrapolation, CFS led to a reduction of at least HK $1,200 (US $153) in HAE-related costs per patient per year. Screening using a greater than suggested C4 cutoff of 22.9 mg/dL yielded superior sensitivity (100%) and specificity (77%). CONCLUSION Cascade family screening is an effective approach to family screening in HAE, improving clinical and psychological outcomes, and reducing disease-related costs.
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Şengül Emeksiz Z, Demir İpek K, Tehçi AK, Gürsoy G, Dibek Mısırlıoğlu E. Characteristics of Patients Who Underwent a Diagnostic Test for Hereditary Angioedema Admitted Due to Angioedema. J Trop Pediatr 2022; 68:6640064. [PMID: 35818890 DOI: 10.1093/tropej/fmac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Hereditary angioedema (HAE) is clinically characterized by recurrent attacks of angioedema. This study evaluated the clinical findings and examination results of patients admitted due to angioedema who then underwent a diagnostic test for HAE. The study aimed to assess the contribution of laboratory findings to the diagnostic process and to determine clinicians' level of awareness regarding the differential diagnosis of angioedema and the appropriate laboratory tests. METHODS Pediatric patients suspected to have HAE based on the presence of angioedema and screened for C1 esterase inhibitor levels and/or function were included in the study. RESULTS A total of 136 patients were evaluated for a preliminary diagnosis of HAE in the presence of angioedema. Angioedema was accompanied by urticaria in 65 patients (47.7%) and itching in 24 patients (17.6%). Patients were evaluated using laboratory tests, C4 levels were studied in 124 patients (91.1%) and were found to be within normal reference limits. C1 esterase inhibitor levels were studied in all patients and were found to be within normal limits. C1 esterase inhibitor function was also studied in 101 patients (74.2%) and was found to be within normal limits. DISCUSSION It was concluded that clinicians keep HAE in mind when encountering angioedema, but that increasing their knowledge of clinical findings that assist in differential diagnosis among angioedema types would be useful. The study authors would like to emphasize that this topic should be included in the specialty training curriculum to raise the awareness of clinicians, especially pediatricians, about clinical HAE findings and the algorithmic approach to the differential diagnosis of angioedema.
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Affiliation(s)
- Zeynep Şengül Emeksiz
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Children's Hospital, Ankara City Hospital, Ankara 06800, Turkey
| | - Kezban Demir İpek
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Children's Hospital, Ankara City Hospital, Ankara 06800, Turkey
| | - Ali Kansu Tehçi
- Department of Pediatrics, University of Health Sciences, Ankara Children's Hospital, Ankara City Hospital, Ankara 06800, Turkey
| | - Gamze Gürsoy
- Department of Pediatrics, University of Health Sciences, Ankara Children's Hospital, Ankara City Hospital, Ankara 06800, Turkey
| | - Emine Dibek Mısırlıoğlu
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Children's Hospital, Ankara City Hospital, Ankara 06800, Turkey
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Ohsawa I, Honda D, Suzuki Y, Fukuda T, Kohga K, Morita E, Moriwaki S, Ishikawa O, Sasaki Y, Tago M, Chittick G, Cornpropst M, Murray SC, Dobo SM, Nagy E, Van Dyke S, Reese L, Best JM, Iocca H, Collis P, Sheridan WP, Hide M. Oral berotralstat for the prophylaxis of hereditary angioedema attacks in patients in Japan: A phase 3 randomized trial. Allergy 2021; 76:1789-1799. [PMID: 33247955 PMCID: PMC8247297 DOI: 10.1111/all.14670] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/23/2020] [Accepted: 11/08/2020] [Indexed: 12/20/2022]
Abstract
Background With no approved treatments in Japan for the prevention of hereditary angioedema (HAE) attacks, there is a significant unmet need for long‐term prophylactic therapies for Japanese patients with HAE. Berotralstat (BCX7353) is an oral, once‐daily, highly selective inhibitor of plasma kallikrein in development for prophylaxis of angioedema attacks in HAE patients. Methods APeX‐J is a phase 3, randomized, double‐blind, placebo‐controlled, parallel‐group, 3‐part trial conducted in Japan (University Hospital Medical Information Network identifier, UMIN000034869; ClinicalTrials.gov identifier, NCT03873116). Patients with a clinical diagnosis of type 1 or 2 HAE underwent a prospective run‐in period of 56 days to determine eligibility, allowing enrollment of those with ≥2 expert‐confirmed angioedema attacks. Patients were randomly assigned (1:1:1) and stratified by baseline attack rate (≥2 vs. <2 expert‐confirmed attacks/month between screening and randomization) to receive once‐daily berotralstat 110 mg, berotralstat 150 mg, or placebo. The primary endpoint was the rate of expert‐confirmed angioedema attacks during dosing in the 24‐week treatment period. Results Nineteen patients were randomized to receive once‐daily berotralstat 110 mg (n = 6), berotralstat 150 mg (n = 7), or placebo (n = 6). Treatment with berotralstat 150 mg significantly reduced HAE attacks relative to placebo (1.11 vs. 2.18 attacks/month, p = .003). The most frequently reported treatment‐emergent adverse events (TEAEs) in berotralstat‐treated patients (n = 13) were nasopharyngitis (n = 4, 31%), abdominal pain, cough, diarrhea, and pyrexia (n = 2 each, 15%). Conclusions Orally administered, once‐daily berotralstat 150 mg significantly reduced the frequency of HAE attacks and was safe and well tolerated, supporting its use as a prophylactic therapy in patients with type 1 or 2 HAE in Japan.
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Affiliation(s)
- Isao Ohsawa
- Internal Medicine Saiyu Soka Hospital Saitama Japan
- Division of Nephrology Department of Internal Medicine Juntendo University Faculty of Medicine Tokyo Japan
| | | | - Yusuke Suzuki
- Division of Nephrology Department of Internal Medicine Juntendo University Faculty of Medicine Tokyo Japan
| | | | | | | | | | | | - Yoshihiro Sasaki
- National Hospital Organization Disaster Medical Center Tokyo Japan
- Division of Biochemistry Department of Biomedical Sciences Nihon University School of Medicine Tokyo Japan
| | - Masaki Tago
- Department of General Medicine Saga University Hospital Saga Japan
| | | | | | | | | | - Eniko Nagy
- BioCryst Pharmaceuticals, Inc Durham NC USA
| | | | - Lacy Reese
- BioCryst Pharmaceuticals, Inc Durham NC USA
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Ozeki T, Mizuno M, Iguchi D, Kojima H, Kim H, Suzuki Y, Kinashi H, Ishimoto T, Maruyama S, Ito Y. C1 inhibitor mitigates peritoneal injury in zymosan-induced peritonitis. Am J Physiol Renal Physiol 2021; 320:F1123-F1132. [PMID: 33818127 DOI: 10.1152/ajprenal.00600.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Peritonitis, due to a fungal or bacterial infection, leads to injury of the peritoneal lining and thereby forms a hazard for the long-term success of peritoneal dialysis (PD) and remains a lethal complication in patients with PD. This study investigated whether C1 inhibitor (C1-INH) could protect against the progression of peritoneal injuries with five daily administrations of zymosan after mechanical scraping of the rat peritoneum to mimic fungal peritonitis. Severe peritoneal injuries were seen in this model, accompanied by fibrinogen/fibrin exudation and peritoneal deposition of complement activation products such as activated C3 and C5b-9. However, intraperitoneal injection of C1-INH decreased peritoneal depositions of activated C3 and C5b-9, ameliorated peritoneal thickening, reduced the influx of inflammatory cells, and prevented the production of peritoneal fibrous layers with both one and two doses of C1-INH each day. Our results suggest that C1-INH might be useful to protect against peritoneal injuries after causes of peritonitis such as fungal infection. This clinically available agent may thus help extend the duration of PD.NEW & NOTEWORTHY Peritoneal injuries associated with peritonitis comprise an important issue to prevent long-term peritoneal dialysis (PD) therapy. Here, we showed that C1 inhibitor (C1-INH), as an anticomplement agent, protected against peritoneal injuries in a peritonitis animal model related to fungal infection. Therefore, C1-INH might be useful to protect against peritoneal injuries after peritonitis due to fungal infection. This clinically available agent may thus help extend the duration of PD.
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Affiliation(s)
- Toshikazu Ozeki
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Iguchi
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kojima
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hangsoo Kim
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takuji Ishimoto
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
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Tanaka H, Tanaka K, Enomoto N, Takakura S, Magawa S, Maki S, Nii M, Toriyabe K, Katsuragi S, Ikeda T. Reference range for C1-esterase inhibitor (C1 INH) in the third trimester of pregnancy. J Perinat Med 2021; 49:166-169. [PMID: 32887189 DOI: 10.1515/jpm-2020-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objectives of this study were to (i) establish the reference range and mean value for normal levels of C1-esterase inhibitor (C1 INH) during pregnancy, and (ii) investigate the association between C1 INH and uterine atony, as measured by blood loss at delivery. METHODS We prospectively studied 200 healthy pregnant women who were registered. We studied C1 INH levels in 188 women at 34 and 35 gestational weeks of pregnancy. The reference range for C1 INH during the third trimester of pregnancy was calculated using the value of C1 INH that was determined at registration. RESULTS The mean value of C1 INH was determined to be 70.3% (95% confidence interval, 68.7-71.9). While the C1 INH levels in four women were determined to be 40% lower than the calculated mean value, amniotic fluid embolism (AFE) did not occur in any of the women studied. CONCLUSIONS This study successfully demonstrated that a reference value for C1 INH activity can be established using the methods described herein. Further research is needed to determine whether C1 INH is involved in obstetric coagulopathy syndrome such as amniotic fluid embolism.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan
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A case of hereditary angioedema (type III) in which mandibular wisdom tooth extraction was performed under intravenous sedation management without prophylactic administration of C1–INH. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hide M, Fukunaga A, Maehara J, Eto K, Hao J, Vardi M, Nomoto Y. Efficacy, pharmacokinetics, and safety of icatibant for the treatment of Japanese patients with an acute attack of hereditary angioedema: A phase 3 open-label study. Allergol Int 2020; 69:268-273. [PMID: 31672405 DOI: 10.1016/j.alit.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is a genetic disease characterized by recurrent swelling episodes affecting the skin, gastrointestinal mucosa, and upper respiratory tract. METHODS A phase 3, single-arm, open-label study was performed to evaluate a selective bradykinin B2 receptor antagonist, icatibant, for the treatment of acute attacks in Japanese patients with HAE Type I or II. After the onset of an acute attack, icatibant 30 mg was administered by the patient or a healthcare professional via subcutaneous injection in the abdomen. RESULTS Eight patients who had an attack affecting the skin (n = 4), abdomen (n = 3), or larynx (n = 1) were treated with icatibant (3 of the injections were self-administered). The median time to onset of symptom relief was 1.75 h (95% confidence interval, 1.00-2.50), and all patients had symptom relief within 5 h after administration. The time to maximum plasma concentration of icatibant was 1.79 h, and the maximum plasma concentration was 405 ng/ml. Seven patients experienced an injection site reaction, and 3 patients had adverse events (2 patients had a worsening or repeat HAE attack 29.0 and 18.3 h after icatibant administration, respectively, and 1 had headache). CONCLUSIONS Although the number of patients is small, the efficacy and tolerability of icatibant for acute attacks were demonstrated in Japanese patients with HAE, regardless of self-administration or administration by healthcare professional.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Institute of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8551, Japan.
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Maehara
- Emergency and General Medicine Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kazunori Eto
- Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan
| | - James Hao
- Shire, a Takeda Company, Lexington, MA, USA
| | | | - Yuji Nomoto
- Department of Palliative Care Internal Medicine, Niigata City General Hospital, Niigata, Japan
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Affiliation(s)
- Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Japan
- Center for Research, Education, And Treatment of angioEdema (CREATE), a specified Non-profit Corporation, Japan
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Horiuchi T, Hide M, Yamashita K, Ohsawa I. The use of tranexamic acid for on-demand and prophylactic treatment of hereditary angioedema-A systematic review. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Takahiko Horiuchi
- Department of Internal Medicine; Kyushu University Beppu Hospital; Beppu Oita Japan
| | - Michihiro Hide
- Department of Dermatology; Graduate School of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - Kouhei Yamashita
- Department of Hematology; Kyoto University Hospital; Kyoto Japan
| | - Isao Ohsawa
- Department of Nephrology; Saiyu Soka Hospital; Soka Saitama Japan
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Satomura A, Fujita T, Nakayama T. Comparison of the Frequency of Angioedema Attack, before and during Pregnancy, in a Patient with Type I Hereditary Angioedema. Intern Med 2018; 57:751-755. [PMID: 29093422 PMCID: PMC5874354 DOI: 10.2169/internalmedicine.9407-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 38-year-old Japanese woman who had been diagnosed with hereditary angioedema type I at 7 years of age based on her family history. She had undergone four pregnancies. She gave birth to a healthy baby girl after her first pregnancy and had reported few episodes of angioedema. However, she subsequently required abortions due to frequent angioedema episodes that occurred during her three subsequent pregnancies. Thus, our patient showed two clinical pregnancy courses. After treating her with C1-inhibitor concentrate, her symptoms of angioedema disappeared. The preventive use of C1 inhibitor concentrates should be considered in hereditary angioedema (HAE) patients with frequent angioedema attacks during pregnancy.
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Affiliation(s)
- Atsushi Satomura
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
| | - Takayuki Fujita
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
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Ohsawa I, Honda D, Hisada A, Inoshita H, Onda-Tsueshita K, Mano S, Sato N, Nakamura Y, Shimizu T, Gotoh H, Goto Y, Suzuki Y, Tomino Y. Clinical Features of Hereditary and Mast Cell-mediated Angioedema Focusing on the Differential Diagnosis in Japanese Patients. Intern Med 2018; 57:319-324. [PMID: 29093383 PMCID: PMC5827308 DOI: 10.2169/internalmedicine.8624-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The present study was designed to identify the clinical characteristics that permit the differential diagnosis of hereditary angioedema (HAE) and mast cell-mediated angioedema (Mast-AE) during the first consultation. Methods The medical histories and laboratory data of 46 patients with HAE and 41 patients with Mast-AE were compared. Results The average age of onset in the HAE group (19.8±9.0 years) was significantly lower than that in the Mast-AE group (35.2±12.0 years). The incidence of familial angioedema (AE) in the HAE group (73.9%) was significantly higher than that in the Mast-AE group (9.7%). The frequency of history of AE in the extremities, larynx, or gastrointestinal tract was significantly higher in the HAE group. The frequency of AE episodes of the lips and eyelids was significantly lower in the HAE group. The serum C4 concentration and CH50 titer were lower than the normal limit in 91.3% and 45.6% of the patients in the HAE group, respectively; in Mast-AE group the serum C4 concentration and CH50 titer were significantly lower than the normal limit in 4.8% and 0% of the patients, the difference between the two groups was statistically significant. A C1-inhibitor (C1-INH) activity level of <50% was observed in all of the HAE patients, but none of the Mast-AE patients. The mean serum IgE titer in the HAE group (120.8±130.5 IU/mL) was significantly lower than that in the Mast-AE group (262.2±314.9 IU/mL). Conclusion The parameters within the patients' medical histories, such as the age at the onset of AE, a family history of AE, and the locations of past AE episodes are critical for the successful diagnosis of the disease. Measurements of the C4 and C1-INH activity are very useful for differential diagnosis of HAE from Mast-AE.
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Affiliation(s)
- Isao Ohsawa
- Nephrology Unit, Saiyu Soka Hospital, Japan
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | - Daisuke Honda
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | - Atsuko Hisada
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
- Department of Nephrology, Ikegami General Hospital, Japan
| | - Hiroyuki Inoshita
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | - Kisara Onda-Tsueshita
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | - Satoshi Mano
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
| | - Nobuyuki Sato
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
- Deprtment of Internal Medicine, Niigata Rosai Hospital, Japan
| | | | - Tatsuo Shimizu
- Nephrology Unit, Saiyu Soka Hospital, Japan
- Department of Internal Medicine, Saiyu Kawaguchi Clinic, Japan
| | | | | | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Japan
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14
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Mizuno M, Suzuki Y, Ito Y. Complement regulation and kidney diseases: recent knowledge of the double-edged roles of complement activation in nephrology. Clin Exp Nephrol 2017; 22:3-14. [DOI: 10.1007/s10157-017-1405-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/14/2017] [Indexed: 12/28/2022]
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15
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Hirose T, Kimbara F, Shinozaki M, Mizushima Y, Yamamoto H, Kishi M, Kiguchi T, Shiono S, Noborio M, Fuke A, Akimoto H, Kimura T, Kaga S, Horiuchi T, Shimazu T. Screening for hereditary angioedema (HAE) at 13 emergency centers in Osaka, Japan: A prospective observational study. Medicine (Baltimore) 2017; 96:e6109. [PMID: 28178173 PMCID: PMC5313030 DOI: 10.1097/md.0000000000006109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hereditary angioedema (HAE) with deficiency of C1 inhibitor (C1-INH) is an autosomal-dominant disease characterized by recurrent episodes of potentially life-threatening angioedema. The objective is to study the incidence of HAE among patients who visit the emergency department.This was a 3-year prospective observational screening study involving 13 urban tertiary emergency centers in Osaka prefecture, Japan. Patients were included if they met the following criteria: unexplained edema of the body, upper airway obstruction accompanied by edema, anaphylaxis, acute abdomen with intestinal edema (including ileus and acute pancreatitis), or asthma attack. C1-INH activity and C4 level were measured at the time of emergency department admission during the period between July 2011 and June 2014.This study comprised 66 patients with a median age of 54.0 (IQR: 37.5-68.3) years. Three patients were newly diagnosed as having HAE, and 1 patient had already been diagnosed as having HAE. C1-INH activity levels of the patients with HAE were below the detection limit (<25%), whereas those of non-HAE patients (n = 62) were 106% (IQR: 85.5%-127.0%) (normal range, 70%-130%). The median level of C4 was significantly lower in the patients with HAE compared with those without HAE (1.2 [IQR: 1-3] mg/dL vs 22 [IQR: 16.5-29.5] mg/dL, P < 0.01) (normal range, 17-45 mg/dL).Three patients with undiagnosed HAE were diagnosed as having HAE in the emergency department during the 3-year period. If patients have signs and symptoms suspicious of HAE, the levels of C1-INH activity and C4 should be measured.
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Affiliation(s)
- Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
- Emergency and Critical Care Medical Center, Osaka Police Hospital
| | - Futoshi Kimbara
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital
| | | | - Yasuaki Mizushima
- Senshu Trauma and Critical Care Center, Rinku General Medical Center
| | | | - Masashi Kishi
- Emergency and Critical Care Medical Center, Osaka Police Hospital
| | | | - Shigeru Shiono
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine
| | - Mitsuhiro Noborio
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital
| | - Akihiro Fuke
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Takaaki Kimura
- Department of Critical Care Medical Center, Kinki University School of Medicine
| | - Shinichiro Kaga
- Department of Trauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
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16
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Horiuchi T, Tsukamoto H. Complement-targeted therapy: development of C5- and C5a-targeted inhibition. Inflamm Regen 2016; 36:11. [PMID: 29259684 PMCID: PMC5725830 DOI: 10.1186/s41232-016-0013-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 01/27/2023] Open
Abstract
The complement system is a major effector of humoral immunity and natural immunity. The complement system has three independent pathways of complement activation: a classical pathway, an alternative pathway, and a lectin pathway. These pathways converge to a common pathway that activates C3. This pathway also leads to the formation of various bioactive molecules such as C5a and the formation of membrane attack complex on the surface of target cells. In the past, the only preparations with anti-complementary action were C1 inhibitors (C1-INH), but an anti-C5 monoclonal antibody (eculizumab) appeared a few years ago, and this antibody has yielded encouraging results. In addition, a C5a receptor (C5aR) antagonist is in the clinical trial phase, and this antagonist should also prove efficacious. Anti-complement agents have garnered attention as a new treatment strategy for refractory inflammatory diseases.
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Affiliation(s)
| | - Hiroshi Tsukamoto
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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17
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Review of Select Practice Parameters, Evidence-Based Treatment Algorithms, and International Guidelines for Hereditary Angioedema. Clin Rev Allergy Immunol 2016; 51:193-206. [DOI: 10.1007/s12016-016-8546-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Yakushiji H, Kaji A, Suzuki K, Yamada M, Horiuchi T, Sinozaki M. Hereditary Angioedema with Recurrent Abdominal Pain in a Patient with a Novel Mutation. Intern Med 2016; 55:2885-2887. [PMID: 27725554 PMCID: PMC5088555 DOI: 10.2169/internalmedicine.55.6951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a patient with hereditary angioedema type I. The patient had experienced recurrent abdominal pain around the time of her menstrual period for 13 years. A laboratory examination showed reduced functional and antigenic levels of C4 and C1 inhibitor (C1-INH). To establish a diagnosis, we carried out a DNA analysis of the patient's C1-INH gene. We determined that the patient was heterozygous for a single base pair transposition of T to C at nucleotide 4429 in exon 4, which had not been reported in the literature. As the patient had no family history of hereditary diseases, it was considered to be a de novo mutation.
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Affiliation(s)
- Hiromasa Yakushiji
- Emergency and Critical Care Center, Kishiwada Tokushukai Hospital, Japan
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19
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Moldovan D, Bernstein JA, Cicardi M. Recombinant replacement therapy for hereditary angioedema due to C1 inhibitor deficiency. Immunotherapy 2015; 7:739-52. [DOI: 10.2217/imt.15.44] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hereditary angioedema is a rare genetic condition transmitted as an autosomal dominant trait and characterized most commonly by the production of either inadequate or nonfunctioning C1 esterase inhibitor (C1-INH), a blood protein that regulates proteases in the complement, fibrinolytic and contact systems. Patients with hereditary angioedema suffer from episodic, unpredictable manifestations of edema affecting multiple anatomical locations, including the GI tract, facial tissue, the upper airway, oropharynx, urogenital region and/or the arms and legs. A rational approach to treatment is replacement of C1-INH protein, to normalize the levels of C1-INH activity and halt the progression of the biochemical activation processes underlying the edema formation. Ruconest is a highly purified recombinant human C1-INH. This article will focus on the results of ten clinical studies demonstrating the efficacy and safety of Ruconest® (Pharming Group NV, Leiden, the Netherlands), which is now approved for use in Europe, Israel and the USA.
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Affiliation(s)
- Dumitru Moldovan
- University of Medicine & Pharmacy, Mures County Hospital, 1 Marinescu St, 540103 Tîrgu Mures, Romania
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, 231 Albert Sabin Way ML#563 Room 7413, Cincinnati, OH 45267-0563, USA
| | - Marco Cicardi
- Department of Biomedical & Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
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20
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Ohsawa I, Honda D, Nagamachi S, Hisada A, Shimamoto M, Inoshita H, Mano S, Tomino Y. Clinical manifestations, diagnosis, and treatment of hereditary angioedema: survey data from 94 physicians in Japan. Ann Allergy Asthma Immunol 2015; 114:492-8. [PMID: 25872948 DOI: 10.1016/j.anai.2015.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/04/2015] [Accepted: 03/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare and potentially life-threatening condition that results from mutations in the C1 inhibitor (C1-INH). Awareness of HAE among physicians in Japan is increasing, but real-world data are lacking. OBJECTIVE To explore the clinical manifestations, diagnosis, quality of life (QOL), and treatment of Japanese patients with HAE. METHODS A 14-point survey was developed and sent to 387 physicians in Japan (March to May 2014) to gather clinical data on their HAE patients' family history, severity and frequency of attacks, QOL, and therapy use. RESULTS Data on 171 HAE patients were collected from 94 physicians (24.3% response rate). Of the patients, 76.6% had a family history of angioedema (AE), and 11.7% had experienced a death in the family due to an AE attack. HAE type I occurred in 99 patients (57.9%), HAE type II occurred in 9 patients (5.3%), HAE with normal C1-INH occurred in 3 patients (1.8%), and an additional 60 patients were unclassified. Mean time from initial symptoms to diagnosis was 13.8 years. Attacks that required airway management and abdominal surgery with uncertain diagnosis were observed in 9.5% and 2.9% of patients, respectively. In the past year, 21.0% of patients presented with more than 10 attacks, 21.1% were admitted to the hospital for more than 1 day, and 28.7% were absent from work or school. On-demand C1-INH concentrate and prophylactic tranexamic acid were used in approximately half of the patients (47.4% and 39.2%, respectively). CONCLUSION HAE is a severe condition characterized by recurrent AE attacks. In Japan, delayed patient diagnosis and limited use of HAE-specific therapies exacerbate the burden on HAE patients.
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Affiliation(s)
- Isao Ohsawa
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Daisuke Honda
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Seiji Nagamachi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuko Hisada
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mamiko Shimamoto
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroyuki Inoshita
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Mano
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
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Horiuchi T. The ABC of angioedema: ace inhibitor, bradykinin, and C1-inhibitor are critical players. Intern Med 2015; 54:2535-6. [PMID: 26466685 DOI: 10.2169/internalmedicine.54.5130] [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: 11/06/2022] Open
Affiliation(s)
- Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Japan
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22
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Ohsawa I, Nagamachi S, Suzuki H, Honda D, Sato N, Ohi H, Horikoshi S, Tomino Y. Leukocytosis and high hematocrit levels during abdominal attacks of hereditary angioedema. BMC Gastroenterol 2013; 13:123. [PMID: 23915279 PMCID: PMC3735392 DOI: 10.1186/1471-230x-13-123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of hereditary angioedema (HAE) is often delayed due to the low awareness of this condition. In patients with undiagnosed HAE, abdominal symptoms often create the risk of unnecessary surgical operation and/or drug therapy. To explore the cause of misdiagnosis, we compared the laboratory findings of HAE patients under normal conditions with those during abdominal attacks. METHODS Patient medical histories were analyzed and laboratory data at the first consultation with no symptoms and no medication were compared with those at visits to the emergency department during severe attacks. RESULTS Fourteen HAE patients were enrolled. Initial HAE symptoms occurred at 20.2 ± 9.4 years of age. The correct diagnosis of HAE was made 22.7 ± 14.2 years after the initial symptoms. A common site of angioedema was the extremities. Half of the patients experienced a life-threatening laryngeal attack and/or severe abdominal pain. In the patients with severe abdominal pain, significant leukocytosis with neutrophilia along with increased levels of hematocrit were observed while levels of C-reactive protein (CRP) remained low. All severe attacks were alleviated with an infusion of C1-inhibitor concentrate. CONCLUSIONS Consideration of the likelihood of a HAE attack is important when patients present with acute abdominal pain and leukocytosis without elevation of CRP.
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Affiliation(s)
- Isao Ohsawa
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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