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Betschel SD, Caballero T, Jones DH, Longhurst HJ, Manning M, van Kooten S, Heckmann M, Danese S, Goga L, Burnette AF. The complexities of decision-making associated with on-demand treatment of hereditary angioedema (HAE) attacks. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:43. [PMID: 39049074 PMCID: PMC11271048 DOI: 10.1186/s13223-024-00903-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Hereditary angioedema (HAE) is characterized by debilitating attacks of tissue swelling in various locations. While guidelines recommend the importance of early on-demand treatment, recent data indicate that many patients delay or do not treat their attacks. OBJECTIVE This survey aimed to investigate patient behavior and evaluate the key factors that drive on-demand treatment decision-making, as reported by those living with HAE. METHODS People living with HAE were recruited by the US Hereditary Angioedema Association (HAEA) to complete a 20-minute online survey between September 6, and October 19, 2022. RESULTS Respondents included 107 people with HAE, 80% female, 98% adults (≥ 18 years). Attack management included on-demand therapy only (50%, n = 53) or prophylaxis with on-demand therapy (50%, n = 54). Most patients (63.6%) reported that they did not carry on-demand treatment at all times when away from home. The most common reason for not carrying on-demand treatment when away from home was 'prefer to treat at home' (72.1%). Overall, 86% of respondents reported delaying on-demand treatment, despite recognizing the initial onset of an HAE attack and despite 97% of patients agreeing that it is important to recover quickly from an HAE attack. Reasons for non-treatment or treatment delay included 'the attack is not severe enough to treat' (91.9% and 88.0%, respectively), 'cost of treatment' (31.1% and 40.2%, respectively), anxiety about refilling the prescription for on-demand treatment quickly (31.1% and 37.0%, respectively), the pain (injection or burning) associated with their on-demand treatment (18.9% and 28.3%, respectively), the lack of a suitable/private area to administer on-demand treatment (17.6% and 27.2%, respectively), lack of time to prepare on-demand treatment (16.2% and 16.3%, respectively), and a 'fear of needles' (13% and 12.2%, respectively). Survey findings from the patient perspective revealed that when on-demand treatment was delayed, 75% experienced HAE attacks that progressed in severity, and 80% reported longer attack recovery. CONCLUSIONS Survey results highlight that decision-making regarding on-demand treatment in HAE is more complicated than expected. The burden associated with current parenteral on-demand therapies is often the cause of treatment delay, despite acknowledgment that delays may result in progression of HAE attacks and longer time to recovery.
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Affiliation(s)
- Stephen D Betschel
- Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Teresa Caballero
- Servicio de Alergia, Hospital Universitario la Paz, CIBERER U754, IdiPAZ Group 44, Madrid, Spain
| | | | - Hilary J Longhurst
- Department of Medicine, University of Auckland and Auckland City Hospital, Te Toka Tumai, Auckland, New Zealand
| | - Michael Manning
- Allergy, Asthma & Immunology Associates, Ltd., Internal Medicine, UA College of Medicine-Phoenix, Scottsdale, AZ, USA
| | | | | | | | - Ledia Goga
- Division of Allergy and Immunology, Howard University Hospital, Washington, DC, USA
| | - Autumn Ford Burnette
- Department Division Director Clinical Immunology and Allergy, Staff Clinical Immunologist and Allergist, University of Toronto, St. Michael's Hospital, 36 Toronto St, Suite 700, Toronto, ON, M5C 2C5, Canada
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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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Maurer M, Buttgereit T, Magerl M, Schön K, Balla Z, Farkas H. Patient-physician interactions in hereditary angioedema-Key learnings from the coronavirus disease 2019 pandemic. Clin Transl Allergy 2023; 13:e12300. [PMID: 37746793 PMCID: PMC10492262 DOI: 10.1002/clt2.12300] [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: 05/23/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The coronavirus disease pandemic and its containing measures have caused concerns for patients with hereditary angioedema (HAE) and their treating physicians. Both faced challenges surrounding interaction, and communication had to adapt to facilitate appropriate management. Specifically, the pandemic resulted in reduced in-person contact in clinics. Where possible, telemedicine appointments were offered and treatment outside the hospital setting was encouraged. BODY: The pandemic markedly affected patient-physician communication, which is essential to maintain partnerships and optimize care. Although patients with HAE are often experts in their condition, guidance by their physicians is essential, especially with the recent shift toward patient-centered management for rare diseases and shared decision-making (SDM). SDM enables patients to take control of their disease and allows the risks and benefits of treatment to be discussed with their physicians. This review explores perspectives from patients and physicians in the HAE clinical setting, particularly regarding their experiences with communication throughout the pandemic. We discuss the importance of SDM in rare diseases such as HAE, factors that impact effective communication, and potential solutions. CONCLUSION Since patient-centered care and SDM have particular relevance in rare diseases in general, we believe our findings could be transferrable and applicable in the management of other rare diseases.
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Affiliation(s)
- Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE)Institute of AllergologyCharité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE)Institute of AllergologyCharité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE)Institute of AllergologyCharité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | | | - Zsusanna Balla
- Hungarian Angioedema Center of Reference and Excellence (ACARE)Department of Internal Medicine and HaematologySemmelweis UniversityBudapestHungary
- HNO‐Praxis SchaffhausenSchaffhausenSwitzerland
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence (ACARE)Department of Internal Medicine and HaematologySemmelweis UniversityBudapestHungary
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Bellanti JA, Settipane RA. Asthma biomarkers and COVID-19 continue to dominate current medical issues. Allergy Asthma Proc 2022; 43:363-367. [PMID: 36065102 PMCID: PMC9465642 DOI: 10.2500/aap.2022.43.220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Riedl MA, Neville D, Cloud B, Desai B, Bernstein JA. Shared decision-making in the management of hereditary angioedema: An analysis of patient and physician perspectives. Allergy Asthma Proc 2022; 43:397-405. [PMID: 35820771 DOI: 10.2500/aap.2022.43.220050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent, localized episodes of edema. Current treatment guidelines highlight the importance of shared decision-making (SDM) during implementation of HAE management plans. Objective: To determine what constitutes a successful SDM approach in HAE management. Method: Qualitative telephone interviews, which lasted ∼1 hour, were conducted with four HAE physicians and four patients from the APeX-S trial. The physicians were asked to describe the structure and/or content of typical HAE prophylaxis consultations and factors to consider when selecting medications for long-term treatment. Insights from these interviews were used to develop an SDM process diagram. The patients were interviewed to assess how closely the diagram fit their perspectives on the HAE consultation and their involvement in decisions that concerned their care. Interview transcripts were assessed by the interviewer to determine the degree of SDM involvement in each consultation by using qualitative criteria from the literature. Results: Two physicians followed a high-SDM format, and one physician used a "blended" approach. The fourth physician followed a standard (low SDM) format. A successful SDM approach was found to require pre-visit planning, a commitment on behalf of the physician to use SDM methods to learn more about the patient, and empowerment of the patient to reflect on and vocalize his or her preferences and/or needs. Patients engaged in SDM were more likely to proactively request a treatment switch. Conclusion: The adoption of validated HAE-specific treatment decision aids, as well as measures to change the mindsets of patients and physicians, may facilitate successful implementation of SDM in HAE.Clinical Trial Registration: The APeX-S trial was registered with clinicaltrials.gov (NCT03472040).
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Affiliation(s)
- Marc A Riedl
- From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | | | | | - Bhavisha Desai
- BioCryst Pharmaceuticals, Inc., Durham, North Carolina; and
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Bellanti JA, Settipane RA. Long-COVID and loss of smell: A post-COVID olfactory dysfunction that continues to challenge the allergist/immunologist. Allergy Asthma Proc 2022; 43:93-95. [PMID: 35317885 DOI: 10.2500/aap.2022.43.220008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Specific Targeting of Plasma Kallikrein for Treatment of Hereditary Angioedema: A Revolutionary Decade. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:716-722. [PMID: 34838707 DOI: 10.1016/j.jaip.2021.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/01/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022]
Abstract
Hereditary angioedema (HAE) is a rare, chronic, genetic disease that presents with nonpruritic angioedema of the face, extremities, airway (can be life-threatening), genitourinary system, and abdomen. These symptoms can significantly impair daily activities. Hereditary angioedema is classified into HAE owing to a deficiency of functional C1INH (HAE-C1INH) or HAE with normal C1INH (HAE-nl-C1INH). Both type I and II HAE-C1INH result from inherited or spontaneous mutations in the SERPING1 gene, which encodes for C1INH. These mutations result in C1INH dysfunction, leading to uncontrolled plasma kallikrein activity with excessive bradykinin production. Bradykinin receptor activation leads to vasodilation, increased vascular permeability, and smooth muscle contractions, resulting in submucosal angioedema through fluid extravasation. Hereditary angioedema nl-C1INH is caused by either a known or unknown genetic mutation. The underlying mechanism of HAE-nl-C1INH is less well understood but is thought to be related to bradykinin signaling. Plasma kallikrein inhibitors have been developed to inhibit the kallikrein-kinin pathway to prevent (prophylactic) and treat on-demand (acute) HAE attacks. Several of these medications are delivered through subcutaneous or intravenous injection, although new and emerging therapies include oral formulations. This article provides a historical review and describes the evolving landscape of available kallikrein inhibitors to treat HAE-C1INH.
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Anderson J, Maina N. Reviewing clinical considerations and guideline recommendations of C1 inhibitor prophylaxis for hereditary angioedema. Clin Transl Allergy 2022; 12:e12092. [PMID: 35079346 PMCID: PMC8764638 DOI: 10.1002/clt2.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE), a rare disease that is characterized by painful and recurring non-allergic swelling episodes, is caused by the deficiency or dysfunction of C1 inhibitor (C1INH) protein. A comprehensive HAE management plan may require long-term prophylaxis (LTP) in addition to on-demand treatment to help "normalize" patients' lives so that they may fully engage in work, school, family, and leisure activities. AIM The main objective of this narrative review is to provide an overview of updated guideline recommendations specific to LTP of HAE and discuss clinical considerations and pharmacologic management options, with a focus on C1INH. MATERIALS AND METHODS The authors reviewed relevant HAE literature for current recommendations regarding LTP and the role of C1NH. RESULTS Acute HAE attacks are treated with on-demand medication; however, there is a consensus that LTP should routinely be considered for risk reduction and prevention of future episodes. The 2017 World Allergy Organization/European Academy of Allergy and Clinical Immunology guidelines recommend that all patients with HAE be evaluated for LTP routinely and the 2020 HAE Association (HAEA) guidelines emphasize that the decision to use LTP should not be based on rigid criteria, but rather should be based on individual patient needs. Both guidelines recommend C1INH as first-line/preferred therapy for LTP in a range of patient types including adults, children/adolescents, and pregnant/lactating patients. The HAEA also recommends the kallikrein inhibitor, lanadelumab, as a first-line option for LTP. HAE pathway-specific agents for LTP have not been associated with notable safety concerns. DISCUSSION Plasma-derived C1INH has been available for 40+ years in Europe and impacts multiple targets within the HAE pathway. C1INH has been used for on-demand treatment and LTP. A subcutaneous formulation of plasma-derived C1INH is approved for LTP and produces functional C1INH activity levels consistently above the threshold needed for protection from HAE attacks. Other pathway-specific options for LTP include the plasma kallikrein inhibitors, lanadelumab-flyo and berotralstat, approved for adults and pediatric patients aged ≥12 years. C1INH is approved for adults and pediatric patients aged ≥6 years. CONCLUSION Assessing the need for LTP is vital in the ongoing dialogue between clinicians and patients, as both disease-related factors and patient preferences may change over time. Among available options for LTP, plasma-derived C1INH is the broadly recommended first-line option for LTP in patients with HAE, including pregnant/lactating women and pediatric patients (≥6 years).
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Affiliation(s)
- John Anderson
- Clinical Research Center of Alabama, AllerVie HealthBirminghamAlabamaUSA
| | - Njeri Maina
- Alabama Allergy and Asthma Center, AllerVie HealthBirminghamAlabamaUSA
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Bellanti JA, Settipane RA. Evaluation and management of adverse reactions to the COVID-2019 vaccines. Allergy Asthma Proc 2022; 43:1-4. [PMID: 34983703 DOI: 10.2500/aap.2022.43.210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Epland K, Wayne M, Pein H. Hereditary Angioedema Management: Individualization. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geng B, Craig TJ. Small molecule drugs for atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. Ann Allergy Asthma Immunol 2021; 128:263-268. [PMID: 34673223 DOI: 10.1016/j.anai.2021.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review recent trends in the development of targeted small molecule drugs (SMDs) for the treatment of immunologically driven disorders, including atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. DATA SOURCES Data sources included peer-reviewed published literature from the PubMed database, published abstracts from scientific and medical meetings, and medication information from the Drugs@FDA database. STUDY SELECTIONS Articles with primary or retrospective trial results, articles with patient or physician survey results, articles providing expert perspectives, and commentary on chronic immunologic disorders, Food and Drug Administration package inserts, and abstracts from scientific meetings were selected. RESULTS Targeted biological therapies have greatly improved response rates and symptom relief for patients with long-term immunologically driven disorders over the past 2 decades. However, recent advances in the understanding of molecular pathways involved in the pathogenesis of these disorders have led to the development of novel targeted SMDs, such as tofacitinib and berotralstat, that can be delivered orally or topically. Few head-to-head studies that compare the safety and efficacy of biologics to SMDs in immunologically driven disorders exist, although some studies suggest that oral and topical modes of administration are preferred by patients and may improve patient quality of life over time. CONCLUSION Scientific advances have led to an increase in the development of targeted SMDs for the treatment of chronic immunologic disorders, which may revolutionize the management of these diseases. Head-to-head studies and real-world evidence are needed to fully compare treatment attributes between biologics and SMDs, including safety, efficacy, adherence, impact on quality of life, and cost-effectiveness.
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Affiliation(s)
- Bob Geng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State University, Hershey Medical Center, Hershey, Pennsylvania.
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Manning ME, Kashkin JM. Berotralstat (BCX7353) is a novel oral prophylactic treatment for hereditary angioedema: Review of phase II and III studies. Allergy Asthma Proc 2021; 42:274-282. [PMID: 34127176 DOI: 10.2500/aap.2021.42.210034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable and potentially life-threatening episodes of swelling in various parts of the body. These attacks can be painful and debilitating, and affect a patient's quality of life. Every patient who experiences an attack should be treated with on-demand medication to mitigate attack severity and duration. Many patients with HAE also receive long-term prophylaxis to reduce the frequency and severity of edema episodes. Although long-term prophylaxis reduces the disease burden for patients with HAE, available intravenous and subcutaneous treatments are accompanied by a significant treatment burden because of the logistical, emotional, and physical challenges posed by their long-term parenteral nature. Androgens are an effective oral prophylactic treatment; however, they are associated with significant adverse events and are not suitable for all patients. Thus, the HAE community has expressed interest in the development of alternative oral prophylactic therapies for preventing HAE attacks. Objective: Here, we review the phase II and III clinical data of berotralstat (BCX7353), which was approved by the U.S. Food and Drug Administration in December 2020. Results: Berotralstat is an oral, second-generation, synthetic, small-molecule plasma kallikrein inhibitor taken once daily for the prevention of HAE attacks in patients ages ≥ 12 years. Results from the APeX studies (APeX-1 NCT02870972, APeX-2 NCT03485911, APeX-S NCT03472040, APex-J NCT03873116) demonstrated the efficacy of berotralstat as long-term prophylaxis for patients with HAE, which showed a reduction in the attack rate and on-demand medication usage. Berotralstat was well tolerated, and gastrointestinal treatment-emergent adverse events were generally mild and self-limited. Conclusion: Oral berotralstat is an effective and safe long-term prophylactic treatment for patients with HAE that will provide patients unable to tolerate parenteral therapies with the option of disease control. Berotralstat may be associated with reduced treatment burden compared with injectable therapies, highlighting the importance of patient preference with regard to the administration route of their HAE prophylactic treatment.
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Affiliation(s)
- Michael E. Manning
- From the Allergy, Asthma and Immunology Associates, Ltd., Scottsdale, Arizona; and
| | - Jay M. Kashkin
- Kashkin Allergy, Asthma and Immunology Center, Fair Lawn, New Jersey
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Bellanti JA, Settipane RA. COVID-19: A continuing challenge for the allergist/immunologist. Allergy Asthma Proc 2021; 42:263-266. [PMID: 34187618 DOI: 10.2500/aap.2021.42.210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Radojicic C, Riedl MA, Craig TJ, Best JM, Rosselli J, Hahn R, Banerji A. Patient perspectives on the treatment burden of injectable medication for hereditary angioedema. Allergy Asthma Proc 2021; 42:S4-S10. [PMID: 33980327 DOI: 10.2500/aap.2021.42.210025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hereditary angioedema (HAE) is a rare, chronic disease characterized by debilitating swelling episodes in various parts of the body. Patients experience significant burdens related to the symptoms and management of HAE, which can affect their daily lives and reduce their overall quality of life. Prophylactic treatment options have expanded in the past decade to the benefit of patients; however, these therapies require scheduled injections, which can be painful, burdensome, and time consuming. We conducted an online survey of patients with HAE in the USA to better understand their experiences with available prophylactic medications and the associated treatment burdens. Our survey results suggest that most patients are satisfied with their current therapies but desire novel medications with a simpler route of administration and that, although most patients experience significant treatment-related burdens, they learn to cope with these challenges over time.
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Affiliation(s)
- Cristine Radojicic
- From the Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Marc A. Riedl
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | - Aleena Banerji
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Riedl MA, Craig TJ, Banerji A, Aggarwal K, Best JM, Rosselli J, Hahn R, Radojicic C. Physician and patient perspectives on the management of hereditary angioedema: a survey on treatment burden and needs. Allergy Asthma Proc 2021; 42:S17-S25. [PMID: 33980329 DOI: 10.2500/aap.2021.42.210017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hereditary angioedema (HAE) is a rare disorder caused by genetic mutations that lead to recurrent episodes of swelling in various parts of the body. Prophylactic treatment is common for patients with HAE, and the therapeutic options have expanded in recent years. The current standard of care for prophylactic HAE therapies is subcutaneous treatment, which can be self-administered at home, greatly improving patient quality of life. As new therapies emerge, it is important for patients and physicians to discuss the risks and benefits associated with each treatment to develop an individualized approach to HAE management. We conducted surveys of patients with HAE and physicians who treat patients with HAE to identify prescribing trends for prophylactic HAE treatments and the impact that such treatments has on patients. Our results confirmed that newer, subcutaneous therapies are prescribed for HAE prophylaxis more frequently than other therapies in the United States and that treatment burdens still exist for patients with HAE. We found that physicians and patients were not always aligned on how treatment choices affect patients' lives, which may mean that there are opportunities for enhanced patient-physician dialog and shared decision-making in HAE management in the United States.
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Affiliation(s)
- Marc A. Riedl
- From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | - Aleena Banerji
- Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Cristine Radojicic
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Bellanti JA, Settipane RA. Hereditary angioedema again revisited. Allergy Asthma Proc 2021; 42:105-107. [PMID: 33685554 DOI: 10.2500/aap.2021.42.210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Bellanti JA, Settipane RA. The challenge of COVID-19 that permeates the practice of allergy/immunology. Allergy Asthma Proc 2021; 42:1-4. [PMID: 33404384 PMCID: PMC7768063 DOI: 10.2500/aap.2021.42.200116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Paige D, Maina N, Anderson JT. Hereditary angioedema: Comprehensive management plans and patient support. Allergy Asthma Proc 2020; 41:S38-S42. [PMID: 33109325 DOI: 10.2500/aap.2020.41.200059] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hereditary angioedema (HAE) is a rare disease. Regardless, patients with HAE have access to multiple state-of-the-art medications available for on-demand use and prevention that reduce the frequency and burden of HAE attacks. These treatments have greatly reduced the burden of disease and helped patients achieve improved quality of life. However, with greater numbers of therapeutic options, HAE care has become more complex. In this review, we addressed essential elements of an individualized comprehensive management plan for a patient with HAE. We focused on access to an expert physician, ongoing patient education, access to effective treatment options, coordination of care and management of treatment logistics, ongoing monitoring of attacks and treatments, and other resources for patient support. This plan will need to be communicated with the patient and other care providers, especially during emergent conditions, and accommodate the patient's lifestyle with consideration for work, school, travel, etc. Periodically, the physician and the patient will need to review information about attacks, triggers, and treatments to identify areas for improvement and update the plan.
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Abstract
Hereditary Angioedema (HAE) is a potentially life-threatening condition. With episodic, unpredictable swelling, HAE negatively affect the quality of life for those affected individuals. To reduce the morbidity and mortality of HAE are the primary goal for the disease management. In addition to have access to therapeutic drugs for their acute HAE attacks, many patients require long term prophylaxis (LTP) to reduce their attack frequency and severity. Preventing HAE attack by regular administration of medicine has become an important part of HAE disease management. Over the past few years, growing number of therapeutic options for the HAE LTP have made it possible for physicians to choose the most appropriate and effective treatment for individual patients. C1 INH concentrate and plasma kallikrein inhibitors (IV or SC) have largely replaced the oder modality of treatment consisting different androgen derivatives or antifibrinolytics. Additional options, such as oral kallikrein inhibitor, antisense RNA/plasma kallikrein, anti-Factor 12a, bradykinin receptor blocker or future gene therapy are under clinical investigation. The significant cost and the uncertainty of its long term safety may be the primary limiting factors for its clinical application. The limited data for young children and pregnant women pose additional challenge for physicians to assess the risk and benefit when considering LTP treatment.
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Affiliation(s)
- Huamin Henry Li
- From the Institute for Asthma and Allergy, Chevy Chase, Maryland
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Castaldo AJ, Riedl MA, Settipane RA, Bellanti JA. A roadmap for optimal care of the patient with hereditary angioedema. Allergy Asthma Proc 2020; 41:S01-S02. [PMID: 33109316 DOI: 10.2500/aap.2020.41.200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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