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Lochbaum R, Trainotti S, Hoffmann TK, Greve J, Hahn J. A clinical evaluation of patients with known mutations (plasminogen and factor XII) with a focus on prophylactic treatment. J DERMATOL TREAT 2024; 35:2290362. [PMID: 38086754 DOI: 10.1080/09546634.2023.2290362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Hereditary angioedema with normal C1-inhibitor (HAE-nC1-INH) is a rare genetic disease. The symptoms can resemble other forms of hereditary angioedema (HAE), but the specific laboratory values are inconspicuous. The knowledge about treatment strategies in HAE-nC1-INH remains insufficient; most of the drugs are only licensed and approved for other types of HAE. METHODS An analysis of all patients with HAE-nC1-INH was carried out in a certified angioedema treatment center in southern Germany. Only patients with a confirmed HAE-nC1-INH mutation were included. The impact of disease was monitored with validated questionnaires. RESULTS Eighteen patients were included: two families with a factor XII mutation and seven families with a plasminogen mutation. All individuals received icatibant for on-demand therapy-efficient treatment response was reported. Three patients were severely affected, and prophylaxis was initiated with lanadelumab. According to the questionnaires, the clinical course and symptoms improved significantly under this prophylactic regime. CONCLUSION This is one of the first descriptions of the clinical outcomes as a response to prophylactic treatment with lanadelumab in HAE-nC1-INH patients with a known mutation. The therapeutic management of HAE-1 and HAE-2 should also be the basis of HAE-nC1-INH, including prophylaxis.
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Affiliation(s)
- Robin Lochbaum
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Susanne Trainotti
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Schlueter M, Nestler-Parr S. Letter to the editor: network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema. J Comp Eff Res 2024; 13:e230165. [PMID: 38545965 PMCID: PMC11036881 DOI: 10.57264/cer-2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Max Schlueter
- IQVIA, The Point, 37 North Wharf Road, London, W2 1AF, UK
| | - Sandra Nestler-Parr
- BioCryst Pharmaceuticals, 4505 Emperor Blvd., Suite 200, Durham, NC 27703, USA
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Abass MK, Dabosy A, Walid Khawaja K, Fischer PR. Repeated attacks of hereditary angioedema in pediatric female. Paediatr Int Child Health 2024; 44:39-41. [PMID: 38404177 DOI: 10.1080/20469047.2024.2317488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
A 16-year-old female presented to an outpatient clinic with a 13-year history of recurrent episodes of abdominal pain, vomiting and mild cutaneous swelling, either spontaneously or following minor trauma. The episodes occurred every 1-2 months. There was no family history of a similar complaint or hereditary angio-oedema (HAE). At the age of 16, evaluation confirmed the diagnosis of HAE type II, characterised by low C4 levels and reduced C1 esterase inhibitor function. The patient was prescribed tranexamic acid 1 g twice daily as well as C1 esterase inhibitor used as rescue medication during symptomatic episodes. This case report emphasises the importance of considering a diagnosis of HAE in patients with recurrent, unexplained abdominal pain, even in the absence of a positive family history of HAE.Abbreviations: ANA Antinuclear antibodies; C1-INH C1-inhibitor; CBC Complete blood count; FMF Familial Mediterranean fever; HAE Hereditary angioedema; IBD Inflammatory bowel diseases; SDP Solvent detergent-treated plasma; SLE Lupus erythematosus.
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Affiliation(s)
- Maha Khalil Abass
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Abdelaly Dabosy
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Pediatric Rheumatology Pediatric Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Khulood Walid Khawaja
- Pediatrics Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Philip R Fischer
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
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Watt M, Malmenas M, Haeussler K. Letter in reply: network meta-analysis for indirect comparison of lanadelumab and for the treatment of hereditary angioedema. J Comp Eff Res 2024; 13:e240041. [PMID: 38606574 PMCID: PMC11036986 DOI: 10.57264/cer-2024-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Maureen Watt
- Global Evidence & Outcomes Director, Takeda Development Center, 95 Hayden Ave, Lexington, MA 02421, USA
| | - Mia Malmenas
- Senior Principal Insights, Evidence & Value – Health Economics Outcomes Research / Epidemiology, ICON plc, Stockholm Norra Bantorget, Olof Palmes Gata 29, 4th Floor, 11122, Stockholm, Sweden
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Riedl MA, Soteres D, Sublett JW, Desai B, Tomita D, Collis P, Bernstein JA. Hereditary angioedema outcomes in US patients switched from injectable long-term prophylactic medication to oral berotralstat. Ann Allergy Asthma Immunol 2024; 132:505-511.e1. [PMID: 38006972 DOI: 10.1016/j.anai.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Berotralstat, a first-line, once-daily, oral plasma kallikrein inhibitor for long-term prophylaxis of hereditary angioedema (HAE), is an effective and well-tolerated treatment option. OBJECTIVE To summarize the safety, effectiveness, and impact on treatment satisfaction in patients who switched from injectable long-term prophylactics to oral berotralstat monotherapy (150 mg daily) at US sites in the international open-label APeX-S study. METHODS APeX-S was an open-label, Phase II study of berotralstat conducted in 22 countries. Here, we focus on APeX-S patients enrolled at US sites who switched from injectable long-term prophylactics to berotralstat 150 mg once-daily monotherapy. RESULTS A total of 34 patients discontinued lanadelumab (n = 21), subcutaneous C1 esterase inhibitor (n = 11), or intravenous C1 esterase inhibitor (n = 2) and switched to berotralstat 150 mg monotherapy. Vomiting, diarrhea, and upper respiratory tract infection were the most common adverse events (each 11.8%). Mean monthly attack rates were consistently low after the switch to berotralstat. The mean (SEM) monthly attack rate was 0.29 (0.11) at Month 1, 0.48 (0.15) at Month 6, and 0.58 (0.23) at Month 12. The median attack rate was 0 attack/mo throughout 12 months of treatment. Improvements were observed in the Treatment Satisfaction Questionnaire for Medication from baseline to Month 12 after the switch to berotralstat monotherapy, with the greatest improvements in convenience. CONCLUSION The transition from injectable prophylactic medication to berotralstat was generally well tolerated. Patients switching to berotralstat monotherapy maintained good control of their HAE symptoms and reported improved treatment satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03472040.
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Affiliation(s)
- Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Daniel Soteres
- Asthma & Allergy Associates P.C., Colorado Springs, Colorado
| | | | | | - Dianne Tomita
- BioCryst Pharmaceuticals, Inc, Durham, North Carolina
| | - Phil Collis
- BioCryst Pharmaceuticals, Inc, Durham, North Carolina
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Cincinnati, Ohio; University of Cincinnati, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology.
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Zanichelli A, Senter R, Merlo A, Gidaro A, Popescu Janu V, Cogliati CB, Cancian M. Comorbidities in Angioedema Due to C1-Inhibitor Deficiency: An Italian Survey. J Allergy Clin Immunol Pract 2024; 12:1029-1036. [PMID: 38182098 DOI: 10.1016/j.jaip.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is characterized by unpredictable recurrent episodes of swelling affecting the skin and the mucosa tissues, including gastrointestinal tract and/or oropharyngeal-laryngeal mucosae. Long-term prophylaxis (LTP) is used to prevent attacks. OBJECTIVE Because C1-INH plays a pivotal role in several biological pathways, we investigated the possible association of comorbidities with C1-INH deficiency and the use of LTP with attenuated androgens (AA) or tranexamic acid (TXA). METHODS This retrospective cohort study involved adult patients with HAE referred to Milan and Padua angioedema centers in the period 1979-2021. A qualitative comparison was performed to analyze comorbidities versus general population. The incidence of comorbidities was evaluated during LTP with AA or TXA versus patients without LTP. RESULTS A total of 446 patients were studied. A greater prevalence among patients was found for heart diseases (9.6% vs 4.8%), acute myocardial infarction (5.6% vs 1.4%), hepatitis C virus infection (10.5% vs 2.5%), and appendectomy (15.9% vs 4.3%). In patients taking AA, a greater incidence was found for hypertension (22.8% vs 10.8%; odds ratio [OR]: 2.02), hypercholesterolemia (19.5% vs 5.3%; OR: 3.97), diabetes mellitus (5% vs 1.4%; OR: 3.21), hepatic angioma (4.4% vs 0.7%; OR: 8.35), and focal nodular hyperplasia (2.5% vs 0.4%; OR: 6.9). No association between TXA and comorbidities was found. CONCLUSION In this large patient population with a rare disease followed for up to a 43-year period, we found a greater prevalence of comorbidities hitherto unreported in the literature and an association between comorbidities and LTP with AA.
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Affiliation(s)
- Andrea Zanichelli
- Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Riccardo Senter
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Andrea Merlo
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Antonio Gidaro
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Valentina Popescu Janu
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Chiara Beatrice Cogliati
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Kumar Jindal A, Basu S, Tyagi R, Barman P, Sil A, Chawla S, Kaur A, Tyagi R, Jangra I, Machhua S, Sendhil Kumaran M, Dogra S, Vinay K, Bishnoi A, Sharma R, Garg R, Saka R, Suri D, Pandiarajan V, Pilania R, Dhaliwal M, Sharma S, Rawat A, Singh S. Delay in diagnosis is the most important proximate reason for mortality in hereditary angio-oedema: our experience at Chandigarh, India. Clin Exp Dermatol 2024; 49:368-374. [PMID: 38039144 DOI: 10.1093/ced/llad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Hereditary angio-oedema (HAE) is a rare autosomal dominant disorder characterized clinically by recurrent episodes of nonpruritic subcutaneous and/or submucosal oedema. Laryngeal oedema is the commonest cause of mortality in patients with HAE. Prior to the availability of first-line treatment options for the management of HAE, mortality was as high as 30%. Mortality has significantly declined in countries where first-line treatment options are available and patients can access these therapies. There is a paucity of literature on the outcomes of patients with HAE in developing countries where availability of and access to first-line treatment options are still a challenge. OBJECTIVES To report our experience on mortality in patients with HAE and to report factors associated with the death of these patients. METHODS We carried out a record review of all patients diagnosed with HAE between January 1996 and August 2022. Families with HAE who had reported the death of at least one family member/relative from laryngeal oedema were studied in detail. RESULTS Of the 65 families (170 patients) registered in the clinic, 16 families reported the death of at least one family member/relative from laryngeal oedema (total of 36 deaths). Of these 16 families, 14 reported that 1 or more family members had experienced at least 1 attack of laryngeal oedema. One patient died during follow-up when she was taking long-term prophylaxis with stanozolol and tranexamic acid, while the remaining 35 patients were not diagnosed with HAE at the time of their death. At the time of death of all 36 patients, at least 1 other family member had symptoms suggestive of HAE, but the diagnosis was not established for the family. CONCLUSIONS To our knowledge, this is the largest single-centre cohort of patients with HAE in India reporting mortality data and factors associated with death in these families. The delay in diagnosis is the most important reason for mortality.
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Affiliation(s)
- Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reva Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archan Sil
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanchi Chawla
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anit Kaur
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Isheeta Jangra
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanghamitra Machhua
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Garg
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchi Saka
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Pandiarajan
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Dhaliwal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saniya Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Boursiquot JN, Chapdelaine H, St-Pierre C, Hébert J. The Disease Burden of Hereditary Angioedema: Insights from a Survey in French-Canadians from Quebec. J Immunol Res 2024; 2024:3028617. [PMID: 38487730 PMCID: PMC10940028 DOI: 10.1155/2024/3028617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/24/2024] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
Background Limited data are available on the clinical profile and disease burden of hereditary angioedema (HAE) in Canadians. Objective This study aimed to assess HAE disease characteristics and the burden of disease in Canadians with HAE types I, II, and normal levels of C1 inhibitor (nC1-INH). Materials and Methods A 46-item patient survey evaluating clinical characteristics and burden of disease was developed and disseminated by the HAE patient organization Angio-oédeme héréditaire du Québec in Quebec, Canada, from May 2019 to February 2020. The survey received Research Review Board ethics approval. Results In the 35 respondents, HAE type I was the most common (46%), followed by nC1-INH (43%). Female participants were significantly younger at first symptom presentation than males (p=0.04). Prior to diagnosis, 69% of participants underwent unnecessary treatments and procedures, with a 10-year delay between first symptoms and diagnosis. Before starting the current treatment, 42% of participants experienced weekly HAE attacks. Most participants identified experiencing attacks in the abdomen (89%), followed by the larynx (66%), feet (66%), hands (63%), and face (63%). Most attacks were severe or moderate, yet almost half of patients waited >1 hr before getting medical attention at their last emergency department (ED) visit. HAE was associated with decreased health-related quality of life, leading to significant functional impairment in personal and professional life. As compared to HAE type I/II, patients with HAE nC1-INH were treated more often with tranexamic acid for long-term prophylaxis, and their condition was less controlled, resulting in more attacks and ED visits. Conclusion HAE manifests in this patient population as frequent moderate-to-severe attacks and a high disease burden; the HAE subtype may differentially affect care requirements. There is an urgent need for increased awareness and education on HAE among treating physicians.
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Affiliation(s)
| | - Hugo Chapdelaine
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Québec, Canada
- Institut de Recherches Cliniques de Montréal, Québec, Canada
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Ding L, Zhang MJ, Rao GW. Summary and future of medicine for hereditary angioedema. Drug Discov Today 2024; 29:103890. [PMID: 38246415 DOI: 10.1016/j.drudis.2024.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/24/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Hereditary angioedema (HAE) is a rare autosomal genetic disease for which there are currently nine FDA-approved drugs. This review summarizes drug treatments for HAE based on four therapeutic pathways: inhibiting the contact system, inhibiting bradykinin binding to B2 receptors, supplying missing C1 inhibitors, and inhibiting plasminogen conversion. The review generalizes the clinical use, pharmacological effects and mechanisms of HAE drugs, and it also discusses possible development directions and targets to enhance understanding of HAE and help researchers.
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Affiliation(s)
- Lei Ding
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Meng-Jiao Zhang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China
| | - Guo-Wu Rao
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, PR China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, PR China.
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Farkas H, Balla Z. Kallikrein inhibitors for angioedema: the progress of preclinical and early phase studies. Expert Opin Investig Drugs 2024; 33:191-200. [PMID: 38366937 DOI: 10.1080/13543784.2024.2320700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/15/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent edema and predominantly caused by the dysregulation of the kinin-kallikrein system. AREAS COVERED This manuscript presents the results of preclinical and early clinical trials of newer drugs targeting the dysregulated kinin-kallikrein system. ATN-249 is an oral drug that has shown promising results in preclinical and Phase I studies, and good tolerability in the prophylactic treatment of attacks. KVD900 is also an oral agent developed for the on-demand treatment of HAE attacks. It has shown positive results in Phase I/II studies, with rapid absorption. The third drug, IONIS-PKKRx, is an antisense oligonucleotide targeting plasma prekallikrein mRNA. It has shown a dose-dependent reduction of plasma prekallikrein levels and proenzyme activation in Phase I/II studies, and has shown promising results. STAR-0215 is a long acting anti-activated kallikrein monoclonal antibody. A Phase 1a single ascending dose trial evaluated its safety, pharmacokinetics, and pharmacodynamics. Lastly, NTLA-2002 is an investigational gene-editing therapy. EXPERT OPINION The targeted treatment of the dysregulated kinin-kallikrein system with specific inhibitors is promising for the prevention of angioedema attacks. Ongoing phase III studies will provide further insight into the efficacy and long-term safety of these novel therapies, potentially expanding treatment options for HAE treatment.
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Affiliation(s)
- Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal, Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal, Medicine and Haematology, Semmelweis University, Budapest, Hungary
- HNO-Praxis Schaffhausen, Schaffhausen, Switzerland
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Petersen RS, Bordone L, Riedl MA, Tachdjian R, Craig TJ, Lumry WR, Manning ME, Bernstein JA, Raasch J, Zuraw BL, Deng Y, Newman KB, Alexander VJ, Lui C, Schneider E, Cohn DM. A phase 2 open-label extension study of prekallikrein inhibition with donidalorsen for hereditary angioedema. Allergy 2024; 79:724-734. [PMID: 38009241 DOI: 10.1111/all.15948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a potentially fatal disease characterized by unpredictable, recurrent, often disabling swelling attacks. In a randomized phase 2 study, donidalorsen reduced HAE attack frequency and improved patient quality-of-life (ISIS721744-CS2, NCT04030598). We report the 2-year interim analysis of the phase 2 open-label extension (OLE) study (ISIS 721744-CS3, NCT04307381). METHODS In the OLE, the on-treatment study period consisted of fixed (weeks 1-13, donidalorsen 80 mg subcutaneously every 4 weeks [Q4W]) and flexible (weeks 17-105, donidalorsen 80 mg Q4W, 80 mg every 8 weeks [Q8W], or 100 mg Q4W) dosing periods. The primary outcome was incidence and severity of treatment-emergent adverse events (TEAEs). The secondary outcomes included efficacy, pharmacodynamic, and quality-of-life assessments. RESULTS Seventeen patients continued in the OLE study. No serious TEAEs or TEAEs leading to treatment discontinuation were reported. Mean monthly HAE attack rate was 96% lower than the study run-in baseline rate (mean, 0.06/month; 95% confidence interval [CI], 0.02-0.10; median, 0.04 on-treatment vs. mean, 2.70/month; 95% CI, 1.94-3.46; median, 2.29 at baseline). Mean monthly attack rate for Q8W dosing (n = 8) was 0.29 (range, 0.0-1.7; 95% CI, -0.21 to 0.79; median, 0.00). Mean plasma prekallikrein and D-dimer concentrations decreased, and Angioedema Quality of Life Questionnaire total score improved from baseline to week 105 with donidalorsen. CONCLUSION The 2-year interim results of this phase 2 OLE study of donidalorsen in patients with HAE demonstrated no new safety signals; donidalorsen was well tolerated. There was durable efficacy with a 96% reduction in HAE attacks.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Bordone
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | - Marc A Riedl
- University of California San Diego, La Jolla, California, USA
| | - Raffi Tachdjian
- Department of Pediatrics, University of California, Los Angeles, California, USA
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
- Vinmec International Hospital, Times City, Hanoi, Vietnam
| | - William R Lumry
- Allergy and Asthma Research Associates Research Center, Dallas, Texas, USA
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Jason Raasch
- Midwest Immunology Clinic, Plymouth, Minnesota, USA
| | - Bruce L Zuraw
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Yiwen Deng
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | | | - Cindy Lui
- Ionis Pharmaceuticals, Inc., Carlsbad, California, USA
| | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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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. J Allergy Clin Immunol Pract 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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Longhurst HJ, Lindsay K, Petersen RS, Fijen LM, Gurugama P, Maag D, Butler JS, Shah MY, Golden A, Xu Y, Boiselle C, Vogel JD, Abdelhady AM, Maitland ML, McKee MD, Seitzer J, Han BW, Soukamneuth S, Leonard J, Sepp-Lorenzino L, Clark ED, Lebwohl D, Cohn DM. CRISPR-Cas9 In Vivo Gene Editing of KLKB1 for Hereditary Angioedema. N Engl J Med 2024; 390:432-441. [PMID: 38294975 DOI: 10.1056/nejmoa2309149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Hereditary angioedema is a rare genetic disease that leads to severe and unpredictable swelling attacks. NTLA-2002 is an in vivo gene-editing therapy based on clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9. NTLA-2002 targets the gene encoding kallikrein B1 (KLKB1), with the goal of lifelong control of angioedema attacks after a single dose. METHODS In this phase 1 dose-escalation portion of a combined phase 1-2 trial of NTLA-2002 in adults with hereditary angioedema, we administered NTLA-2002 at a single dose of 25 mg, 50 mg, or 75 mg. The primary end points were the safety and side-effect profile of NTLA-2002 therapy. Secondary and exploratory end points included pharmacokinetics, pharmacodynamics, and clinical efficacy determined on the basis of investigator-confirmed angioedema attacks. RESULTS Three patients received 25 mg of NTLA-2002, four received 50 mg, and three received 75 mg. At all dose levels, the most common adverse events were infusion-related reactions and fatigue. No dose-limiting toxic effects, serious adverse events, grade 3 or higher adverse events, or clinically important laboratory findings were observed after the administration of NTLA-2002. Dose-dependent reductions in the total plasma kallikrein protein level were observed between baseline and the latest assessment, with a mean percentage change of -67% in the 25-mg group, -84% in the 50-mg group, and -95% in the 75-mg group. The mean percentage change in the number of angioedema attacks per month between baseline and weeks 1 through 16 (primary observation period) was -91% in the 25-mg group, -97% in the 50-mg group, and -80% in the 75-mg group. Among all the patients, the mean percentage change in the number of angioedema attacks per month from baseline through the latest assessment was -95%. CONCLUSIONS In this small study, a single dose of NTLA-2002 led to robust, dose-dependent, and durable reductions in total plasma kallikrein levels, and no severe adverse events were observed. In exploratory analyses, reductions in the number of angioedema attacks per month were observed at all dose levels. (Funded by Intellia Therapeutics; ClinicalTrials.gov number, NCT05120830.).
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Affiliation(s)
- Hilary J Longhurst
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Karen Lindsay
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Remy S Petersen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Lauré M Fijen
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Padmalal Gurugama
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Maag
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - James S Butler
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mrinal Y Shah
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Adele Golden
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Yuanxin Xu
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Carri Boiselle
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Joseph D Vogel
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Ahmed M Abdelhady
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Michael L Maitland
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Mark D McKee
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Jessica Seitzer
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Bo W Han
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Samantha Soukamneuth
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - John Leonard
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Laura Sepp-Lorenzino
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Eliana D Clark
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - David Lebwohl
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
| | - Danny M Cohn
- From Te Toka Tumai, Department of Immunology, Auckland City Hospital (H.J.L., K.L.), and the Department of Medicine, University of Auckland (H.J.L.) - both in Auckland, New Zealand; the Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (R.S.P., L.M.F., D.M.C.); Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom (P.G.); and Intellia Therapeutics, Cambridge, MA (D.M., J.S.B., M.Y.S., A.G., Y.X., C.B., J.D.V., A.M.A., M.L.M., M.D.M., J.S., B.W.H., S.S., J.L., L.S.-L., E.D.C., D.L.)
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Calderón O, Muñoz D, Olivares M. [Case series of hereditary angioedema patients and use of tranexamic acid treatments in prophylaxis and acute crisis, experience in Perú]. Rev Alerg Mex 2024; 71:55. [PMID: 38683073 DOI: 10.29262/ram.v71i1.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Hereditary Angioedema (HAE) is a rare disease characterized by episodes of swelling, HAE crisis could cause death by suffocation, and also affect the quality of life in these patients. There exists an important disparity of HAE specific treatments between countries, inclusive in the same region, currently in Perú we use moderate and high doses of Tranexamic Acid (TA) in prophylaxis therapy and in acute HAE crisis respectively. OBJECTIVE To report our experience with TA in three types of HAE patients and be a guide to other countries with this therapy, where HAE specific treatments are not registered. CASE REPORT Patient 1: Woman. 49 years old. HAE-1. Symptoms began at the age of 12. Her final diagnosis was at age 45. Usually presents an acute crisis every two months approximately, she receives 2 g IV of TA when lips, tongue, facial episodes is beginning, eventually she needed other 1 - 2 g IV (after 4 hours). She receives Long-Term Prophylaxis (LTP) with TA (500 - 750 mg)/12 h. Patient 2: Woman 47 years old, HAE nC1INH-FXII. Symptoms began at the age of 19, during her first pregnancy, her definitive diagnosis was at the age of 41 years. She maintains a prophylaxis treatment of TA (750 mg-1,5 g)/daily; upper airway attacks are treated immediately with TA doses (1 - 2 g) when the crisis is beginning. Patient 3: Woman 43 years old, HAE-nC1INH-U. Genetic study did not recognize SERPING1, PLG1, ANGPT1, KNG1, FXII, mutations. Symptoms began at age 4, and her final diagnosis was at age 36. When the attack is beginning, she immediately receives TA (500 - 750 mg) orally / 12 hours during 2 to 3 days with acceptable tolerance and control of the HAE episodes. While the patients receive TA prophylaxis treatment doses (500 - 750 mg) every 8 or 12 hours respectively, the HAE episodes are less symptomatic and resolve in a few days. CONCLUSIONS We found this systematic review, used TA orally, on-demand and prophylaxis therapy, maximum cumulative dose 3 g/24 h1. In our HAE patients, we used TA up to 4 g (2 g - 2 g) intravenous for control of acute crisis in a interval of 4 hours, when decreases the reaction, the orally maintenance dose should be prescribed, 1 g/8 h with a progressive decrease of the dose in the next days. Tranexamic Acid treatment was useful in our different types of HAE patients. Most of our patients use high doses of TA to slow down and stop slowly the HAE crisis. TA is probably an option in countries where specific treatments are not registered, it could be administered orally and/or intravenous. High doses of TA were well tolerated and with acceptable response in HAE attacks.
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Affiliation(s)
- Oscar Calderón
- Angioedema Centers of Reference and Excellence-ACARE, Clínica El Golf - Grupo SANNA, San Isidro, Lima. Perú
- Médico Monitor de la Asociación de Pacientes con Angioedema Hereditario del Perú
- Comité de Angioedema Hereditario, de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI)
- Asociación Latinoamericana de Angioedema Hereditario (ALAEH).
| | - Danny Muñoz
- Angioedema Centers of Reference and Excellence-ACARE, Clínica El Golf - Grupo SANNA, San Isidro, Lima. Perú
- Comité de Angioedema Hereditario, de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI)
| | - Margarita Olivares
- Clínica Medellín Sede El Poblado, Medellín, Colombia
- Comité de Angioedema Hereditario, de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI)
- Asociación Latinoamericana de Angioedema Hereditario (ALAEH)
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15
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Tachdjian R, Savic S, Fridman M, Frade JP, Fasehun M, Audhya PK. Real-world reporting rates of administration-site reactions with on-demand treatment of hereditary angioedema attacks. Allergy Asthma Proc 2024; 45:37-43. [PMID: 37993116 DOI: 10.2500/aap.2024.45.230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Background: Hereditary angioedema (HAE) is characterized by recurrent and unpredictable episodes of subcutaneous and/or submucosal swelling. Objective: To characterize the real-world treatment burden associated with existing on-demand therapies, we analyzed administration-site adverse drug reactions (ADR) associated with approved on-demand HAE therapies reported in the U.S. Food and Drug Administration's (FDA) Adverse Event Reporting System (FAERS). Methods: We searched the FAERS database from October 1, 2009, to March 31, 2022, for reports of all FDA-approved on-demand therapies for HAE: plasma-derived C1-inhibitor (pdC1-INH), ecallantide, icatibant, and recombinant C1-inhibitor (rhC1-INH). ADRs in which the drug was listed as the "primary suspect" were recorded for each drug. ADR preferred terms were grouped into 18 ADR domains based on semantic and/or clinical similarity, and the number of reports for each drug was calculated per year from the time of approval through March 2022, and descriptive results were presented. Preferred terms associated with administration-site ADRs identified from clinical trials and denoted on approved HAE drug U.S. package inserts were examined in a complementary analysis. Results: The highest reported rates of administration-site ADRs per year were site pain (17.9 reports per year), site erythema (7.4 per year), and site swelling (6.7 per year). RhC1-INH was the only drug for which access-site complications and/or malfunctions were reported (9.5 per year). PdC1-INH had the highest rate of incorrect route of product administration (3.7 per year). PdC1-INH showed statistically significant elevated reporting rate of injection-site reactions (reporting odds ratio [ROR] 3.59 [2.36-5.46]; empirical Bayesian geometric mean [EBGM] 1.97 [1.39]). Icatibant and rhC1-INH showed a statistical trend toward an increased reporting rate of administration-site reactions. Conclusion: Real-world data from FAERS were generally consistent with adverse events reported in clinical trials and suggest that patients experience substantial treatment burden associated with FDA-approved parenteral on-demand therapies for HAE attacks. It should be noted that ADR rates are not exposure adjusted and are based on spontaneous reporting.
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Affiliation(s)
- Raffi Tachdjian
- From the University of California, Los Angeles, School of Medicine, Los Angeles, California
| | - Sinisa Savic
- School of Medicine, University of Leeds, Leeds, England
| | | | - Joao P Frade
- KalVista Pharmaceuticals, Cambridge, Massachusetts
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16
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Srinivasan C, Ritchie B, Adatia A. Berotralstat in hereditary angioedema due to C1 inhibitor deficiency: first real-world evidence from a Canadian center. Front Immunol 2024; 15:1339421. [PMID: 38318176 PMCID: PMC10839047 DOI: 10.3389/fimmu.2024.1339421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background Hereditary angioedema due to C1 inhibitor deficiency is a rare genetic condition that causes recurrent swelling with consequent functional impairment and decreased quality of life. Long-term prophylaxis (LTP) to prevent angioedema episodes is a key component of disease management. Berotralstat, an oral, once-daily plasma kallikrein inhibitor, was approved for LTP by Health Canada in 2022. Methods We conducted a retrospective, real-world study investigating the effectiveness and adverse effects of berotralstat. Data on angioedema frequency, disease control, and adverse events were tabulated. Patient satisfaction with treatment was scored on a 5-point Likert scale, with 1 representing very unsatisfied and 5 representing very satisfied with therapy. Results From June, 2022 and May, 2023, 8 patients with HAE type 1 or type 2 received berotralstat. Effectiveness data were available for 7 patients who continued the drug for at least 3 months, 4 of whom switched to berotralstat from plasma-derived C1 inhibitor LTP. In these 7 patients, the average number of attacks per month decreased from 3.3 to 1.6 (p<0.05), representing a ~52% reduction in attack frequency. Median angioedema control test score numerically improved from 8 to 13 (p=0.0781). Of the 8 patients who received berotralstat, 3 reported no adverse effects and 5 experienced gastrointestinal side effects, which were mild and transient in 3 and led to discontinuation in 1. Average treatment satisfaction was between satisfied and very satisfied at 4.3. Conclusion Berotralstat is an effective agent for long-term prophylaxis in HAE. Most patients experienced no adverse effects or mild, transient gastrointestinal symptoms.
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Affiliation(s)
- Cindy Srinivasan
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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17
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Kırmızıtaş Aydoğdu A, Ürel Demir G. Clinical Evaluation of Pediatric Patients with Hereditary Angioedema. TOHOKU J EXP MED 2024; 262:23-27. [PMID: 37793880 DOI: 10.1620/tjem.2023.j083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Hereditary angioedema is a rare, potentially life-threatening disease. There is a lack of data describing the clinical course of hereditary angioedema (HAE) in children. We aimed to evaluate the clinical characteristics of pediatric patients with hereditary angioedema: The age of disease onset, age at diagnosis, the frequency of angioedema attacks, the total number of attacks before diagnosis, the regions where angioedema attacks were observed, accompanying abdominal pain, and serum levels of C4 and C1 esterase inhibitor were obtained and recorded. In addition, the results of SERPING1 (C1INH) gene sequence analysis of the patients in this group were also collected from medical records and recorded. While none of the patients reported a skin rash as a symptom of attack, there was formication observed in the region of angioedema in 46.9% (n = 15) of the patients and pruritus in 6.2% (n = 2) of the patients. At disease onset, the complaints of the patients regarding location of edema were on the hands of 32.3% (n = 10), on the feet of 9.7% (n = 3), on the faces of 25.7% (n = 8), and abdominal attacks in 32.3% of the patients (n = 10). Four different variants, one of which was novel, were detected in the SERPING1 gene in eight different families. The results of this study suggest that hereditary angioedema is diagnosed only when the patient requests examination following recurrent angioedema. Severe laryngeal edema attacks in patients without a diagnosis of HAE are fatal at a higher rate than attacks in patients with a diagnosis. Thus, awareness of the symptoms of HAE is necessary, and correct diagnosis is essential to proper treatment.
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Kalmi G, Nguyen Y, Amarger S, Aubineau M, Bibes B, Blanchard-Delaunay C, Boccon-Gibod I, Bouillet L, Coppo P, Dalmas MC, Debord-Peguet S, Defendi F, Demoreuil C, Du-Thanh A, Gayet S, Hadjadj J, Jeandel PY, Launay D, Ly KH, Avoy CM, Niault M, Ollivier Y, Pelletier F, Porneuf M, Roos-Weil D, Fain O, Gobert D. Efficacy and Safety of Rituximab-Based Treatments in Angioedema With Acquired C1-Inhibitor Deficiency. J Allergy Clin Immunol Pract 2024; 12:212-222. [PMID: 37844846 DOI: 10.1016/j.jaip.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Angioedema (AE) due to acquired C1-inhibitor (C1-INH) deficiency (AAE-C1-INH) is related to excessive consumption of C1-INH or to anti-C1-INH antibodies, and is frequently associated with lymphoproliferative syndromes or monoclonal gammopathies. Standard of care for prophylactic treatment in this condition is not established. Rituximab may be effective to prevent attacks, especially if the lymphoid hemopathy is controlled, but data are scarce. OBJECTIVE To evaluate efficacy of rituximab in AAE-C1-INH. METHODS A retrospective multicenter study was carried out in France, including patients with AAE-C1-INH treated with rituximab between April 2005 and July 2019. RESULTS Fifty-five patients with AAE-C1-INH were included in the study, and 23 of them had an anti-C1-INH antibody. A lymphoid malignancy was identified in 39 patients, and a monoclonal gammopathy in 9. There was no associated condition in 7 cases. Thirty patients received rituximab alone or in association with chemotherapy (n = 25). Among 51 patients with available follow-up, 34 patients were in clinical remission and 17 patients had active AE after a median follow-up of 3.9 years (interquartile range, 1.5-7.7). Three patients died. The presence of anti-C1-INH antibodies was associated with a lower probability of AE remission (hazard ratio, 0.29 [95% CI, 0.12-0.67]; P = .004). Relapse was less frequent in patients with lymphoma (risk ratio, 0.27 [95% CI, 0.09-0.80]; P = .019) and in patients treated with rituximab and chemotherapy (risk ratio, 0.31 [95% CI, 0.12-0.79]; P = .014). CONCLUSIONS Rituximab is an efficient and well-tolerated therapeutic option in AE, especially in lymphoid malignancies and in the absence of detectable anti-C1-INH antibodies.
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Affiliation(s)
- Galith Kalmi
- Internal Medicine Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.
| | - Yann Nguyen
- Internal Medicine Department, Nord-Université Paris Cité, AP-HP, Hôpital Beaujon, Clichy-sous-Bois, France
| | - Stephanie Amarger
- Dermatology Department, University Hospital, Clermont-Ferrand, France
| | - Magali Aubineau
- Internal Medicine Department, Hospices Civils de Lyon, Lyon, France
| | - Beatrice Bibes
- Internal Medicine Department, Saint Grégoire Hospital, Rennes, France
| | | | - Isabelle Boccon-Gibod
- Internal Medicine Department, French National Reference Center for Angioedema (CREAK), Grenoble University Hospital, Grenoble, France
| | - Laurence Bouillet
- Internal Medicine Department, French National Reference Center for Angioedema (CREAK), Grenoble University Hospital, Grenoble, France; University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France; Internal Medicine Department, University Hospital La Tronche, Grenoble, France
| | - Paul Coppo
- Hematology Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | | | - Federica Defendi
- Immunology Department, Grenoble University Hospital, Grenoble, France
| | - Claire Demoreuil
- Internal Medicine Department, La Cavale Blanche University Hospital, Brest, France
| | - Aurélie Du-Thanh
- Dermatology Department, Montpellier University Hospital, Montpellier, France
| | - Stephane Gayet
- Internal Medicine Department, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jerôme Hadjadj
- Internal Medicine Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - David Launay
- Internal and Immunological Medicine Department, Lille Hospital, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille University, INSERM F-59000, Lille, France
| | - Kim Heang Ly
- Internal Medicine Department, Dupuytren University Hospital, Limoges, France
| | - Chloé Mc Avoy
- Internal Medicine Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Mathilde Niault
- Hematology Department, Hôpital du Scorff-Lorient, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Yann Ollivier
- Medicine Department, Cote de Nacre University Hospital, Caen, France
| | - Fabien Pelletier
- Dermatology Department, Allergology Center, Besançon University Hospital, Besançon, France
| | - Marc Porneuf
- Hematology Department, Centre Hospitalier Yves le Foll, Saint-Brieuc, France (x)Hematology Department, Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Damien Roos-Weil
- Hematology Department, Centre Hospitalier Yves le Foll, Saint-Brieuc, France (x)Hematology Department, Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Olivier Fain
- Internal Medicine Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Delphine Gobert
- Internal Medicine Department, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
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Magerl M, Schiffhorst G, Fanter L, Müller G, Hirche C, Berkemeier F, Aygören E. Patient-level indirect treatment comparison of lanadelumab versus pdC1-INH i.v. in hereditary angioedema patients: PATCH study. Allergy 2024; 79:215-224. [PMID: 37641968 DOI: 10.1111/all.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is an autosomal dominant inherited disease in which patients suffer from local attacks primarily affecting skin and gastrointestinal tract, and sometimes even the upper respiratory tract leading to asphyxiation. Since head-to-head trials between authorized treatments are lacking, this study compares efficacy and safety of lanadelumab and intravenous plasma-derived C1-esterase inhibitor (pdC1-INH i.v.) in HAE patients on long-term prophylaxis by means of an indirect treatment comparison. METHODS Efficacy and safety of lanadelumab against pdC1-INH i.v. were analyzed in a fully prespecified indirect comparison based on individual patient data (n = 231) from the HELP and CHANGE clinical trials. Primary and secondary efficacy endpoints were compared using a generalized linear model for count data. Confounding variables were identified a priori via systematic literature research and validated by clinical experts. Adjustment of confounders was implemented using a conditional regression model. RESULTS Lanadelumab showed a statistically significant improvement in reduction of HAE attack rates compared to pdC1-INH i.v. across multiple endpoints: Monthly attack rate of patients treated with lanadelumab was less than half compared to pdC1-INH i.v. (Rate ratio: 0.486; 95% CI: 0.253, 0.932). Monthly rate of laryngeal attacks was found to be five times lower for lanadelumab (Rate ratio: 0.2; 95% CI: 0.044, 0.915) and monthly rate of acute treated HAE attacks among lanadelumab patients was about one third of the attack rate of pdC1-INH i.v. patients (Rate ratio: 0.366; 95% CI: 0.185, 0.727). CONCLUSION This study contributes to current knowledge in the treatment of HAE by indicating a statistically significant reduction of HAE attacks under lanadelumab compared to pdC1-INH i.v.
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Affiliation(s)
- Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | | | - Lena Fanter
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Gerrit Müller
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | | | - Emel Aygören
- Universitätsklinikum Frankfurt, Frankfurt, Germany
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20
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Lumry WR, Bernstein JA, Li HH, Levy DS, Jones DH, Padilla BE, Li-Mcleod J, Tachdjian R. An expert panel's review on patients with hereditary angioedema switching from attenuated androgens to oral prophylactic therapy. Allergy Asthma Proc 2024; 45:44-49. [PMID: 38151740 DOI: 10.2500/aap.2024.45.230080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Background: Hereditary angioedema (HAE) is a rare condition marked by swelling episodes in various body parts, including the extremities, upper airway, face, intestinal tract, and genitals. Long-term prophylaxis (LTP), prescribed to control recurring HAE attacks, is integral to its management. Previously, attenuated androgens (AAs) were the only oral LTP options. However, in 2020, berotralstat, an oral plasma kallikrein inhibitor, was approved in the United States. A 2018 survey of adults with HAE type I or type II showed that almost all the patients who used prophylactic HAE medication preferred oral treatment (98%) and felt that it fit their lifestyle better than injectable treatment (96%). Still, guidelines lack consensus on transitioning patients from AAs to alternative oral prophylactic therapy. Objective: This paper aims to share expert insights and patient feedback on transitioning from AAs to berotralstat, an alternative oral prophylactic therapy, from the perspective of clinicians with extensive experience in treating patients with HAE. Methods: A panel of five HAE specialists convened for a virtual half-day roundtable discussion in April 2023. Results: Discussions about transitioning from AAs to berotralstat were prompted by routine consultations, patient inquiries based on independent research, ineffective current treatment, or worsening AA-related adverse effects. For patients who switched from AAs, the physicians reported that the decision was influenced by the alternative therapy's ability to prevent HAE attacks, its safety, and the once-daily administration schedule. All expert panel members identified fewer AA-related adverse effects; better quality of life; and less severe, shorter, and less frequent HAE attacks as clinical or patient goals they hoped to achieve through the treatment switch. Conclusion: The emergence of new, highly specific LTP drugs for HAE calls for the development of comprehensive recommendations and guidelines for transitioning from AAs to alternative oral prophylactic therapy. The expert panel highlighted key factors to consider during the development of such guidelines.
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Affiliation(s)
- William R Lumry
- From the Allergy and Asthma Research Associates Research Center, Dallas, Texas
| | | | - Henry H Li
- Institute for Asthma and Allergy, Chevy Chase, Maryland
| | - Donald S Levy
- Division of Basic and Clinical Immunology, Department of Medicine, University of California at Irvine, Orange, California
| | | | | | | | - Raffi Tachdjian
- Division of Allergy & Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Baptist AP, Freigeh GE, Nelson B, Carpenter L, Arora NS, Wettenstein RP, Craig T, Riedl MA. Hereditary angioedema in older adults: Understanding the patient perspective. Ann Allergy Asthma Immunol 2024; 132:76-81.e2. [PMID: 37852604 DOI: 10.1016/j.anai.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare condition characterized by potentially fatal, recurrent episodes of painful swelling. Whereas there are limited studies evaluating the quality of life of individuals with HAE, none have evaluated the impact of HAE on older adults. OBJECTIVE To evaluate the effect of HAE on older adults through qualitative methodology. METHODS A group of 3 physicians with extensive research and clinical experience in HAE developed a focus group guidebook highlighting issues of importance to older adults. A total of 17 patients with HAE (type I or II) aged 60 years and older participated in focus groups. Three independent reviewers coded each focus group transcript using a thematic saturation approach. RESULTS Reviewers identified 7 core themes from the focus groups. The themes identified encompassed the following: (1) challenges with securing medications and insurance concerns; (2) the experience of living with HAE before the advent of newer and more effective therapeutic options; (3) a worsening of HAE attack frequency and severity with aging; (4) the effects of comorbid conditions such as arthritis, memory loss, and irritable bowel syndrome; (5) changes in HAE with menopause; and (6) changing perspective on HAE with age, the effect of HAE on interpersonal relationships including the decision to have children, and goals for future care and research including support groups and a desire to be included in clinical trials. CONCLUSION Older adults with HAE have specific challenges and concerns that may be unique compared with younger populations. Health care providers should address these to provide optimal care.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - George E Freigeh
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Belinda Nelson
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Laurie Carpenter
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nonie S Arora
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel P Wettenstein
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Timothy Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pennsylvania
| | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
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Maurer M, Lumry WR, Li HH, Aygören-Pürsün E, Busse PJ, Jacobs J, Nurse C, Ahmed MA, Watt M, Yu M. Lanadelumab in Patients 2 to Less Than 12 Years Old With Hereditary Angioedema: Results From the Phase 3 SPRING Study. J Allergy Clin Immunol Pract 2024; 12:201-211.e6. [PMID: 37730089 DOI: 10.1016/j.jaip.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Symptoms of hereditary angioedema (HAE) often first occur during childhood, and HAE attacks in children can be severe and substantially affect health-related quality of life (HRQoL). However, there are no approved long-term prophylaxis treatments for children aged less than 6 years. OBJECTIVE The SPRING Study (NCT04070326) evaluated the safety, pharmacokinetics, and efficacy of lanadelumab and HRQoL in patients aged 2 to less than 12 years. METHODS Over 52 weeks of treatment, patients aged 2 to less than 6 years received lanadelumab 150 mg every 4 weeks (Q4W) and patients aged 6 to less than 12 years received 150 mg every 2 weeks (Q2W) but could switch to Q4W if they were attack-free for 26 weeks. RESULTS We enrolled 21 patients (aged 2 to less than 6 years: n = 4; aged 6 to less than 12 years: n = 17), 20 of whom completed the study. There were no reported serious treatment-emergent adverse events or discontinuations resulting from such events. Treatment-emergent adverse events were reported for 17 patients (81.0%). The most common TEAE was injection site pain. Overall systemic exposure was comparable for both age groups. The mean (SD) attack rate during treatment decreased by 94.8% from baseline (1.84 [1.53] to 0.08 [0.17] attacks/mo), and 16 (76.2%) patients were attack-free. The attack rate reduction in both age groups was similar during the first 26-week fixed-dosing treatment. Seven patients switched from Q2W to Q4W and remained attack-free. A large, clinically meaningful increase in the Pediatric Quality of Life Inventory Generic Core Scale Total Score and a large increase in the Pediatric Quality of Life Inventory Generic Core Scale-Family Impact Module Total Score from baseline to end of study (better HRQoL) were observed. CONCLUSIONS Findings support safety, efficacy, and improved HRQoL with lanadelumab 150 mg Q2W and Q4W regimens for the prevention of HAE attacks in patients aged 2 to less than 12 years.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
| | | | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, Md
| | - Emel Aygören-Pürsün
- Department for Children and Adolescents, Angioedema Centre, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Jacobs
- Allergy and Asthma Clinical Research, Walnut Creek, Calif
| | | | - Mariam A Ahmed
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Maureen Watt
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Ming Yu
- Takeda Development Center Americas, Inc, Lexington, Mass
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Trainotti S, Johnson F, Hahn J, Hofauer B, Greve J, Wollenberg B, Hoffmann TK, Lochbaum R. Acquired Angioedema Due to C1-Inhibitor Deficiency (AAE-C1-INH)-A Bicenter Retrospective Study on Diagnosis, Course, and Therapy. J Allergy Clin Immunol Pract 2023; 11:3772-3779. [PMID: 37716525 DOI: 10.1016/j.jaip.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Acquired angioedema with C1-inhibitor deficiency (AAE-C1-INH) is a rare condition resembling hereditary angioedema (HAE), but with late onset and low C1-inhibitor (C1-INH) due to consumption potentially caused by autoimmune diseases and mainly lymphatic malignancies. Being about 10-fold rarer than HAE, there is limited knowledge and no licensed therapy. OBJECTIVE To report clinical and biological data from a newly described population of 20 patients with AAE-C1-INH assessing diagnostic delay, AAE-C1-INH:HAE-ratio, underlying conditions, and therapeutic management in Germany. METHODS Retrospective data analysis of 20 patients from 2 angioedema centers in southern Germany. RESULTS Median age at symptoms' onset was 64 years (60% females), with predominant swellings of the face (85%) and low levels for C1-INH in almost all patients. The ratio AAE-C1-INH:HAE was 1:9.7. From symptoms' onset to diagnosis of AAE-C1-INH, the median delay was 7.5 months, and between AAE-C1-INH symptoms' onset and diagnosis of the underlying hematological condition (n = 9) it was 4 months (median). Four patients had a history of solid neoplasm, 1 had a papillary thyroid carcinoma as the only potential cause for AAE-C1-INH, with treatment of the malignancy resulting in resolution of AAE-C1-INH. All the symptomatic patients were treated with off-label on-demand icatibant subcutaneously or C1-INH concentrate intravenously, and 6 severely affected patients needed off-label long-term prophylaxis with good symptom control. CONCLUSIONS AAE-C1-INH is characterized by late-onset swellings mainly involving the face and low C1-INH levels. Diagnostic delay for AAE-C1-INH is further decreasing despite being about 10-fold rarer than HAE. Patients severely affected without underlying condition or no indication for treatment could benefit from off-label therapy.
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Affiliation(s)
- Susanne Trainotti
- Department of Otorhinolaryngology, Technical University of Munich, Munich, Germany.
| | - Felix Johnson
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Benedikt Hofauer
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Technical University of Munich, Munich, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Robin Lochbaum
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Escobar JJ, Aguirre J, Ibáñez S, Cid BJ, Campillay R, Gallardo AM, Grau M, Hoyos-Bachiloglu R. Universal Access to On-Demand Treatment of Patients with Hereditary Angioedema, the Chilean Experience. Pediatr Allergy Immunol Pulmonol 2023; 36:130-132. [PMID: 37917067 DOI: 10.1089/ped.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background: In Chile, patients with hereditary angioedema (HAE) type I and type II are protected under Ley Ricarte Soto (LRS), which guarantees access to on demand plasma-derived C1-INH (pdC1-INH) since 2018. We aimed to analyze the first 3 years of LRS. Methods: Review of the LRS database between 2018 and 2021. Results: During the study period, 154 patients were covered by LRS, with an estimated prevalence of HAE in Chile at 0.8:100,000 inhabitants. A delay in diagnosis of 22 years was noted, 50 patients received epinephrine during an attack before the diagnosis of HAE. Mean number of attacks per year was 8, with 50% of adults and 42% of children experiencing more than 1 attack per month. Conclusion: Disease awareness must improve to reduce the diagnostic delay of HAE. Long-term prophylactic medications should be included in LRS to treat patients with high attack rates and control the costs of frequent on-demand treatment with pdC1-INH.
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Affiliation(s)
- Juan J Escobar
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Aguirre
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Samuel Ibáñez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rolando Campillay
- Complejo Asistencial Barros Luco, Santiago, Chile
- Clínica Alemana de Santiago, Santiago, Chile
| | | | - Masumi Grau
- Clínica Alemana de Santiago, Santiago, Chile
- Department of Rheumatology, Hospital San Juan de Dios, Santiago, Chile
| | - Rodrigo Hoyos-Bachiloglu
- Department of Pediatric Infectious Diseases and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Johnson F, Stenzl A, Hofauer B, Heppt H, Ebert EV, Wollenberg B, Lochbaum R, Hahn J, Greve J, Trainotti S. A Retrospective Analysis of Long-Term Prophylaxis with Berotralstat in Patients with Hereditary Angioedema and Acquired C1-Inhibitor Deficiency-Real-World Data. Clin Rev Allergy Immunol 2023; 65:354-364. [PMID: 37914894 PMCID: PMC10847220 DOI: 10.1007/s12016-023-08972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/03/2023]
Abstract
Hereditary angioedema (HAE) and acquired C1-inhibitor deficiency (AAE-C1-INH) are orphan diseases. Berotralstat is a recently licensed long-term prophylaxis (LTP) and the first oral therapy for HAE patients. No approved therapies exist for AAE-C1-INH patients. This study is the first to report real-world clinical data of patients with AAE-C1-INH and HAE who received Berotralstat. All patients treated with Berotralstat were included in this retrospective, bi-centric study. Data was collected from patients' attack calendars and the angioedema quality of life (AE-QoL) and angioedema control test (AECT) questionnaires before treatment, and at 3, 6, and 12 months after treatment and was then analyzed. Twelve patients were included, 3 patients with AAE-C1-INH, 7 patients with HAE type I, and 2 patients with HAE-nC1-INH. One patient (HAE I) quit treatment. Berotralstat was associated with fewer attacks in all groups. After 6 months of treatment, a median decrease of attacks per month was noted for HAE type I patients (3.3 to 1.5) and AAE-C1-INH patients (2.3 to 1.0). No aerodigestive attacks were noted for AAE-C1-INH patients. For HAE-nC1-INH patients, a mean decrease from 3.8 to 1.0 was noted (3 months). For HAE I patients, the total AE-QoL lowered a mean of 24.1 points after 6 months, for HAE-nC1-HAE patients 8.0 points, and for AAE-C1-INH patients 13.7 points. AECT scores increased for HAE I patients (mean: 7.1), HAE-nC1-INH patients (9.0), and AAE-C1-INH patients (4.2) after 6 months. Patients with HAE, HAE-nC1-INH, and AAE-C1-INH treated with Berotralstat showed reduced angioedema attacks and improved AE-QoL and AECT scores.
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Affiliation(s)
- Felix Johnson
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Anna Stenzl
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
| | - Benedikt Hofauer
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Helen Heppt
- University Hospital for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Eva-Vanessa Ebert
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Department Clinical Medicine, Munich, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Department Clinical Medicine, Munich, Germany
| | - Robin Lochbaum
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Susanne Trainotti
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Department Clinical Medicine, Munich, Germany
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Kron K, Joshi S. Pathogenic variant in SERPING1 gene causing autosomal dominant hereditary angioedema in early childhood. BMJ Case Rep 2023; 16:e257212. [PMID: 37923334 PMCID: PMC10626882 DOI: 10.1136/bcr-2023-257212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
A female in early childhood presented with 6 months of transient swelling of multiple areas of her body, often, but not always, associated with minor trauma. Labs drawn were significant for low C4, low CH50, low C1 esterase inhibitor (C1-INH) antigen and low C1-INH function, which is concerning for hereditary angioedema (HAE) with abnormal C1-INH. Genetic testing through the Invitae Hereditary Angioedema Panel revealed a variant in the SERPING1 gene, c.686-7C>G (Intronic), which was classified as a variant of unknown significance, but is likely pathogenic given patient's clinical presentation and recent functional proof of pathogenicity. HAE should be recognised in paediatric patients even without family history. Recognising the symptoms of HAE and confirming diagnosis in early childhood has become more important recently as the first prophylactic therapy, lanadelumab, was approved in February 2023 for long-term prophylaxis in early childhood, which can significantly improve morbidity and quality of life.
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Affiliation(s)
- Kevin Kron
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Shyam Joshi
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Hide M, Wang Y, Dote N, Miyakawa K, Sugiura K, Ishida K. Safety, efficacy, and pharmacokinetics of icatibant treatment in Japanese pediatric patients with hereditary angioedema: A phase 3, open-label study. J Dermatol 2023; 50:1473-1477. [PMID: 37381768 DOI: 10.1111/1346-8138.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/29/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
We evaluated the safety, efficacy, and pharmacokinetics of subcutaneous weight-adjusted icatibant for the treatment of acute hereditary angioedema attacks in Japanese pediatric patients. Two patients (aged 10-13 and 6-9 years) received icatibant for a total of four attacks. Each attack was abdominal and/or cutaneous and was treated with a single icatibant injection. Mild or moderate injection-site reactions were the only adverse events reported. Time to onset of symptom relief was 0.9-1.0 h. Icatibant was rapidly absorbed, with a pharmacokinetic profile consistent with previous studies. Simulated exposure levels were consistent with non-Japanese pediatric patients. These results support the safety and efficacy of icatibant in Japanese pediatric patients.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yi Wang
- Quantitative Clinical Pharmacology, Takeda Development Center Americas Inc., Cambridge, Massachusetts, USA
| | | | - Kou Miyakawa
- Takeda Development Center Japan, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Kenkichi Sugiura
- Takeda Development Center Japan, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Kazuyuki Ishida
- Takeda Development Center Japan, Takeda Pharmaceutical Company Limited, Osaka, Japan
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Aberer W, Altrichter S, Cerpes U, Hawranek T, Schöffl C, Kinaciyan T. [Hereditary angioedema due to C1-inhibitor deficiency, a national disease management programme]. Wien Klin Wochenschr 2023; 135:785-798. [PMID: 38063938 PMCID: PMC10709250 DOI: 10.1007/s00508-023-02298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/18/2023]
Abstract
Hereditary angioedema (HAE) is a rare, painful, disabling and potentially fatal disease, where early diagnosis and effective treatment are critical. These Austrian guidelines for the diagnosis and management of HAE provide instructions and advice on the state of the art management of HAE in Austria in contrast to global guidelines, where the situation of all countries worldwide must be taken into account. Our goal is to help Austrian physicians to consider HAE as a differential diagnosis with corresponding symptoms, to make rational decisions for the diagnosis and management of HAE with C1-inhibitor deficiency (type 1 or type 2). The guidelines provide information on common and important clinical symptoms, diagnostic methods, treatment modalities, available HAE-specific medications in Austria and last but not least to motivate physicians to refer patients to HAE centers for confirmation of the diagnosis and adequate treatment decisions.
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Affiliation(s)
- Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich.
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Österreich
| | - Urban Cerpes
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich
| | - Thomas Hawranek
- Universitätsklinik für Dermatologie und Allergologie, Uniklinikum Salzburg, Salzburg, Österreich
| | - Clemens Schöffl
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich
| | - Tamar Kinaciyan
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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29
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Burton AE, Lindsay-Wiles I, Herron D, Owen A, Elliott J, Metcalfe A, Diwakar L. Hereditary Angioedema patient experiences of medication use and emergency care. Int Emerg Nurs 2023; 71:101339. [PMID: 37713946 DOI: 10.1016/j.ienj.2023.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare inherited illness characterised by recurrent swellings. Four percent of HAE attacks are life threatening throat swellings requiring urgent medical intervention. The aim of this study was to gain an in depth understanding of patient experiences of use of treatment and emergency care. METHODS 65 participants completed an online survey including open ended questions about their experiences and/or completed an in-depth interview. Interview participants were asked to share and talk about up to five images that they felt best represented their life experiences with HAE. Data were analysed using reflexive thematic analysis. RESULTS Treatment experiences highlighted the life changing nature of new treatments and benefits for quality of life, but also illustrated common barriers to treatment administration. Emergency care experiences illustrated how throat attacks and fear of their future occurrence could be traumatic. DISCUSSION Findings indicate that HAE patients need psychological support to process fears and negative experiences. In addition, psychological barriers to treatment administration must be addressed to ensure treatment is used effectively. Education for emergency practitioners is also needed to improve emergency treatment and reduce the psychological burden of delayed emergency care.
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Affiliation(s)
| | | | - Daniel Herron
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Alison Owen
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | - Jade Elliott
- Centre for Psychological Research, Staffordshire University, United Kingdom
| | | | - Lavanya Diwakar
- University Hospitals of North Midlands NHS Trust, United Kingdom
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Takamura S, Nakamura K, Fukuda T. Evaluation of the safety and effectiveness of berotralstat for patients with hereditary angioedema: Report of six cases. J Dermatol 2023; 50:1506-1508. [PMID: 37721445 DOI: 10.1111/1346-8138.16965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Saori Takamura
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kaori Nakamura
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomoo Fukuda
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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31
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Hide M, Ohsawa I, Nurse C, Yu M. Efficacy and safety of lanadelumab in Japanese patients with hereditary angioedema: A phase 3 multicenter, open-label study. J Dermatol 2023; 50:1381-1391. [PMID: 37574953 DOI: 10.1111/1346-8138.16909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
The safety and efficacy of lanadelumab for the prevention of hereditary angioedema (HAE) attacks have not been studied in Japanese patients. We report outcomes from a phase 3, multicenter, open-label study (NCT04180163) of lanadelumab in Japanese patients with HAE. Japanese patients with HAE aged ≥12 years with ≥1 investigator-confirmed HAE attack during the 4-week run-in baseline period were enrolled into the study and received lanadelumab 300 mg every 2 weeks subcutaneously for 52 weeks. Dosing could be reduced to 300 mg every 4 weeks during the second 26-week treatment period if patients had well-controlled symptoms (e.g., attack-free) for 6 months. The primary efficacy endpoint was no investigator-confirmed HAE attacks (attack-free status) during days 0-182. Other outcomes included the rate of investigator-confirmed HAE attacks per month (28 days) and lanadelumab safety. Twelve patients (mean ± SD age 41.9 ± 12.4 years) were enrolled. During the first 26 weeks (days 0-182), five (41.7%) patients were attack-free. The mean ± SD HAE attack rate per month decreased by 74.0%, from 3.8 ± 2.4 during baseline to 1.2 ± 2.6 during the overall 52-week treatment period. There were no deaths or discontinuations due to treatment-emergent adverse events (TEAEs), no severe or serious TEAEs related to lanadelumab, and no positive anti-drug antibody results. The most frequent TEAEs were injection-site reactions (37 events in six patients). Most of the injection-site reaction adverse events were mild in severity. Results of this study support the findings from two global phase 3 studies for lanadelumab use as prophylactic therapy in Japanese patients with HAE.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Isao Ohsawa
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, Soka, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Christina Nurse
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Ming Yu
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
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Tachdjian R, Kaplan AP. A Comprehensive Management Approach in Pediatric and Adolescent Patients With Hereditary Angioedema. Clin Pediatr (Phila) 2023; 62:973-980. [PMID: 36908071 PMCID: PMC10478326 DOI: 10.1177/00099228231155703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Hereditary angioedema (HAE) is a rare autosomal-dominant disorder; most cases are characterized by low plasma levels of C1 esterase inhibitor (C1-INH). Clinical manifestations of HAE due to C1-INH deficiency include unpredictable, acute, recurrent episodes of nonpruritic swelling that can affect the face, trunk, limbs, and the respiratory, gastrointestinal, and genitourinary tracts. Attacks can be disfiguring, disabling, painful, and even life-threatening if laryngeal swelling occurs. Symptoms of HAE generally manifest in childhood. Effective medications are available and approved to treat HAE in children. However, evidence informing use of these medications in pediatric clinical practice is limited. Hereditary angioedema management plans are critical to optimize outcomes and should address on-demand treatment for acute attacks and plans to prevent potentially fatal laryngeal attacks. The plan should also comprise a holistic approach to address nonclinical aspects of HAE, including quality of life (QoL) and psychological issues. This article provides an overview of HAE management principles that health care providers can apply to treat pediatric patients to improve their QoL.
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Affiliation(s)
- Raffi Tachdjian
- UCLA School of Medicine, Los Angeles, CA, USA
- Division of Allergy and Immunology, Providence St. John Medical Center, Santa Monica, CA, USA
| | - Allen P. Kaplan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC, USA
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Eyice Karabacak D, Can A, Demir S, Yegit OO, Colakoglu B, Buyukozturk S, Gelincik AA. How Does Pregnancy and Type of Delivery Affect the Clinical Course of Hereditary Angioedema? Int Arch Allergy Immunol 2023; 184:1216-1224. [PMID: 37673053 DOI: 10.1159/000531074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/28/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Knowledge on the clinical course of hereditary angioedema (HAE) during pregnancy, delivery, and breastfeeding is very limited. In this study, we aimed to evaluate the course of HAE during these periods. METHODS The HAE attacks C1-INH prophylaxis before and during pregnancy and during breastfeeding, and the delivery types were retrospectively determined. The severity of attacks was assessed by a 10-point Visual Analogue Scale (VAS). RESULTS We evaluated 88 pregnancies in 48 HAE patients among whom 20 were primiparous. Among those who had a HAE diagnosis during pregnancy (n = 34), the median attack numbers before pregnancy, during pregnancy, breastfeeding, and after breastfeeding were 17, 39, 24, and 14 (before pregnancy vs. pregnancy, p < 0.001; during pregnancy vs. breastfeeding, p = 0.001). The mean VASs (SD) were 6.59 (1.82), 8.33 (1.58), 7.32 (1.66), and 6.95 (1.90) (before pregnancy vs. pregnancy, p < 0.001; during pregnancy vs. breastfeeding, p = 0.016), respectively. Among those who received a HAE diagnosis after pregnancy (n = 54), the number (59.3%) and the severity (60%) of HAE attacks were high in pregnancy. 47 of the deliveries were normal vaginal delivery (NVD). Regional anesthesia was applied in 8 NVDs. 20 of caesarean deliveries were performed under general anesthesia, and 21 were under spinal anesthesia. Lowest numbers of attacks were found in patients who did not receive anesthesia during NVD (p = 0.001). CONCLUSION The course of HAE can be worse during pregnancy and breastfeeding. NVD is related to fewer HAE attacks and prophylaxis with C1-INH during NVD is not necessary to prevent a HAE attack.
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Affiliation(s)
- Deniz Eyice Karabacak
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Ozan Yegit
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahauddin Colakoglu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Akkor Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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García-Rosas C, López-Tiro JJ, Contreras-Contreras A, Ruiz-Peñaloza M, Ortiz-Monteón ZE. [Experiencia inicial de Lanadelumab en una paciente mexicana con angioedema hereditario tipo I]. Rev Alerg Mex 2023; 70:194. [PMID: 37933935 DOI: 10.29262/ram.v70i3.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Background Hereditary angioedema type 1 (HAE1) is an autosomal dominant disorder, characterized by quantitative and qualitative deficiency of C1 inhibitor, excessive production of bradykinin and causing recurrent angioedema in varying degrees of severity that affects quality of life and life itself. from the patients. Lanadelumab is a human monoclonal antibody, a specific inhibitor of plasma kallikrein, approved for long-term prophylaxis of HAE1. Case report A 59-year-old female patient, diagnosed with HAE 1 since November 1987, without therapeutic response to danazol, fresh frozen plasma, or C1 inhibitor derived from intravenous plasma, requiring 3 to 9 monthly vials of icatibant acetate due to angioedema. laryngeal, cutaneous and visceral with highly altered quality of life indices. Lanadelumab 300 mg subcutaneously every 14 days was started. At the start of treatment, the AECT1 score was 1 point; AE-Qol2: 57 points, AAS3: 32 points, being followed up at 5, 10 and 12 months. After one year of treatment, the records showed an AECT1 of 19 points; AE-Qol2: 36 points and AAS3: 5 points. The requirement for icatibant acetate has been no more than 3 vials per month. Conclusion In accordance with the literature, lanadelumab offered a significant decrease in angioedema activity and a significantly positive impact on the pa- tient's quality of life, confirming that lanadelumab is an effective option for long-term HAE prophylaxis. .
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Zhou M, Luo X, Zhou QL, Zhou WH, Zheng R, Zhang YN, Wu XF, Wu S, Su J, Xiong GW, Cheng Y, Li YT, Zhang PP, Zhang K, Dai M, Huang XK, Shi ZH, Tao J, Zhou YQ, Feng PY, Chen ZG, Yang QT. [Diagnosis and treatment procedures and health management for patients with hereditary angioedema]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1280-1285. [PMID: 37574324 DOI: 10.3760/cma.j.cn112150-20230509-00359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
As a recognized rare and highly fatal disease, hereditary angioedema (HAE) is difficult to diagnose and characterized by recurrent edema involving the head, limbs, genitals and larynx, etc. Diagnosis of HAE is not difficult. However, low incidence and lack of clinical characteristics lead to difficulty of doctors on timely diagnosis and correct intervention for HAE patients. Therefore, it is crucial to improve the awareness of this disease and prevent its recurrence. for HAE patients. In view of absent cognition of doctors and the general public on HAE, patients often suffer from sudden death or become disabled due to laryngeal edema which cannot be treated in time. Thus, based on the Internet mobile terminal platform, the team set up an all-day rapid emergency response system which is provided for HAE patients by setting up "one-click help". The aim is to offer optimization on overall management of HAE and designed the intelligent follow-up management to provide timely assistance and specialized suggestion for patients with acute attacks.
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Affiliation(s)
- M Zhou
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - X Luo
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Q L Zhou
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - W H Zhou
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - R Zheng
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Y N Zhang
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - X F Wu
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - S Wu
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - J Su
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - G W Xiong
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Y Cheng
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Y T Li
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - P P Zhang
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - K Zhang
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - M Dai
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - X K Huang
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Z H Shi
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - J Tao
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Y Q Zhou
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Respiratory and Intensive Care, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - P Y Feng
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Dermatology and Cosmetic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Z G Chen
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Q T Yang
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Arora NS, Nelson B, Carpenter L, Wettenstein RP, Hashmi M, Selva CN, Castaldo AJ, Baptist AP. Consequences of Insurance Coverage Delays and Denials for Patients With Hereditary Angioedema. J Allergy Clin Immunol Pract 2023; 11:2432-2438.e1. [PMID: 37558360 DOI: 10.1016/j.jaip.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare and potentially fatal genetic disease associated with recurrent and unpredictable episodes of angioedema. Although modern therapies have dramatically increased quality of life, insurance changes, delays, and denials are becoming more common. OBJECTIVE To examine the impact of insurance delays and denials on patient health and well-being. METHODS A total of 20 patients with HAE (type 1 and 2) who recently experienced insurance delays or denials completed an online survey, and 19 participated in a follow-up focus group. The survey and focus group addressed the impact of insurance challenges on the use of health care services, work/school attendance, and anxiety. Three independent reviewers coded each focus group transcript using a thematic saturation approach. RESULTS A total of 70% of participants reported an increased frequency of angioedema attacks resulting from insurance delays or denials. More than 50% missed work/school days because of increased attacks, and 90% reported greater anxiety. Twenty-five percent of respondents reported more urgent care or emergency department visits. In focus groups, participants identified specific ways that losing access to medication had a negative impact on their health, family, and work/school life. Insufficient notification of health insurance policy changes and the time and effort required to regain access to medications compounded patients' frustration and anxiety. CONCLUSION Insurance delays and denials have significant impacts on individuals with HAE including (1) increased urgent care and emergency department visits, (2) missed work/school days, (3) higher levels of anxiety, and (4) a negative impact on family life.
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Affiliation(s)
- Nonie S Arora
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Belinda Nelson
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Laurie Carpenter
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Rachel P Wettenstein
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Muzhda Hashmi
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | | | | | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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Yong PFK, Coulter T, El-Shanawany T, Garcez T, Hackett S, Jain R, Kiani-Alikhan S, Manson A, Noorani S, Stroud C, Symons C, Sargur R, Steele C, Alachkar H, Anantharachagan A, Arkwright PD, Bernatoniene J, Bhole M, Brown L, Buckland M, Burns S, Chopra C, Darroch J, Drewe E, Edmonds J, Ekbote A, Elkhalifa S, Goddard S, Grosse-Kreul D, Gurugama P, Hague R, Herriot R, Herwadkar A, Hughes SM, Jones L, Lear S, McDermott E, Kham Murng SH, Price A, Redenbaugh V, Richter A, Riordan A, Shackley F, Stichbury J, Springett D, Tarzi MD, Thomas M, Vijayadurai P, Worth A. A National Survey of Hereditary Angioedema and Acquired C1 Inhibitor Deficiency in the United Kingdom. J Allergy Clin Immunol Pract 2023; 11:2476-2483. [PMID: 37146882 DOI: 10.1016/j.jaip.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Detailed demographic data on people with hereditary angioedema (HAE) and acquired C1 inhibitor deficiency in the United Kingdom are relatively limited. Better demographic data would be beneficial in planning service provision, identifying areas of improvement, and improving care. OBJECTIVE To obtain more accurate data on the demographics of HAE and acquired C1 inhibitor deficiency in the United Kingdom, including treatment modalities and services available to patients. METHODS A survey was distributed to all centers in the United Kingdom that look after patients with HAE and acquired C1 inhibitor deficiency to collect these data. RESULTS The survey identified 1152 patients with HAE-1/2 (58% female and 92% type 1), 22 patients with HAE with normal C1 inhibitor, and 91 patients with acquired C1 inhibitor deficiency. Data were provided by 37 centers across the United Kingdom. This gives a minimum prevalence of 1:59,000 for HAE-1/2 and 1:734,000 for acquired C1 inhibitor deficiency in the United Kingdom. A total of 45% of patients with HAE were on long-term prophylaxis (LTP) with the most used medication being danazol (55% of all patients on LTP). Eighty-two percent of patients with HAE had a home supply of acute treatment with C1 inhibitor or icatibant. A total of 45% of patients had a supply of icatibant and 56% had a supply of C1 inhibitor at home. CONCLUSIONS Data obtained from the survey provide useful information about the demographics and treatment modalities used in HAE and acquired C1 inhibitor deficiency in the United Kingdom. These data are useful for planning service provision and improving services for these patients.
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Affiliation(s)
- Patrick F K Yong
- Department of Allergy and Clinical Immunology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom.
| | - Tanya Coulter
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tariq El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Tomaz Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Scott Hackett
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Ania Manson
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sadia Noorani
- Department of Immunology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Catherine Stroud
- Regional Department of Immunology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Christine Symons
- Department of Clinical Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Ravishankar Sargur
- Department of Clinical Immunology and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Cathal Steele
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Hana Alachkar
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ariharan Anantharachagan
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter D Arkwright
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Jolanta Bernatoniene
- Department of Paediatric Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malini Bhole
- Department of Immunology, The Dudley Group NHS Foundation Trust, Dudley, United Kingdom
| | - Lindsay Brown
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Matthew Buckland
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Siobhan Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charu Chopra
- Department of Clinical Immunology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - James Darroch
- Department of Immunology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Elizabeth Drewe
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jillian Edmonds
- Department of Clinical Immunology, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Anjali Ekbote
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shuayb Elkhalifa
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Dorothea Grosse-Kreul
- Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Padmalal Gurugama
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rosie Hague
- Department of Paediatric Immunology and Infectious Diseases, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Richard Herriot
- Department of Immunology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Archana Herwadkar
- Department of Clinical Immunology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Hughes
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Laura Jones
- Department of Immunology and infectious Diseases, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | - Sara Lear
- Department of Clinical Immunology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Elizabeth McDermott
- Department of Clinical Immunology and Allergy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Sai Hurng Kham Murng
- Department of Clinical Immunology, Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Arthur Price
- Department of Clinical Immunology and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Vyanka Redenbaugh
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Alex Richter
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Fiona Shackley
- Department of Immunology and Infectious Diseases, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Julia Stichbury
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Debbie Springett
- Department of Clinical Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael D Tarzi
- Department of Immunology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Moira Thomas
- Department of Clinical Immunology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Pavaladurai Vijayadurai
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Austen Worth
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Katelaris CH, Grumach AS, Bork K. Angioedema With Normal Complement Studies: What Do We Know? J Allergy Clin Immunol Pract 2023; 11:2309-2314. [PMID: 37343921 DOI: 10.1016/j.jaip.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Angioedema is generally readily recognizable clinically and is characterized by localized nonpitting edema involving subcutaneous, submucosal, or deep dermal tissue caused by increased vascular permeability and extravasation of intravascular fluid. It can occur via a variety of mechanisms. A number of clinical conditions (masqueraders) are occasionally mistaken for angioedema. Clinical classification of the various angioedema forms begins with noting the presence or absence of concurrent urticaria or wheals. Pathogenesis can be considered through two broad categories: mast cell-mediated with release of vasoactive mediators causing angioedema usually associated with urticaria or in the context of an anaphylactic reaction; and bradykinin (BK)-driven, in which increased vascular permeability is mediated by BK. BK-mediated angioedema does not occur with urticaria, nor does it respond to antiallergic medications. The various forms of hereditary angioedema are included in this category, requiring specific tests of C4 and C1 inhibitor level and function to confirm the diagnosis. Angiotensin converting enzyme inhibitors, which impair the degradation of BK, account for up to a third of all patients with angioedema presenting to the emergency department. Finally, angioedema may occur by yet unknown mechanisms; under this circumstance, it is difficult to manage.
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Affiliation(s)
- Constance H Katelaris
- Immunology/Allergy Unit, Department of Medicine, Campbelltown Hospital and Faculty of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - Anete S Grumach
- Clinical Immunology, Department of Clinical Medicine, Faculty of Medicine, Centro Universitario FMABC, Santo Andre, São Paulo, Brazil.
| | - Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Katelaris CH, Boicos K, Button PH, McCloud PI, Burton PK, Perram FA, Youssef S, Tognarini D. Living With Hereditary Angioedema in Australia: Findings From a National Observational Study Using Short Message Service to Monitor the Burden of Disease. J Allergy Clin Immunol Pract 2023; 11:2457-2467.e1. [PMID: 36918098 DOI: 10.1016/j.jaip.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/18/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND To understand the impact and burden of disease experienced by patients with hereditary angioedema (HAE). OBJECTIVE To determine whether the use of short message service (SMS) to communicate with patients with HAE facilitates the collection of attack rate, medication use, and quality of life measurements. METHODS Patients aged 12 years and older with doctor-confirmed HAE C1-inhibitor deficiency types I and II were invited to participate. We devised a novel method for monitoring attacks by using questions weekly via SMS to gain a more accurate picture of the burden of HAE in Australian patients in real time. RESULTS A total of 2,648 weekly SMS messages were sent to 47 participants; 1,892 responses were received (71%). Participants reported 463 attacks across all treatment groups. Sixty percent of attacks were treated. Icatibant and C1-inhibitor concentrate were administered IV for 210 and 67 attacks, respectively. Of the 463 recorded attacks, 23 necessitated presentation to the hospital (5%), predominantly for facial and/or throat swelling. Several participants reported attacks (n = 186), which they chose not to treat. Most of those attacks were rated mildly severe. Twenty-one participants reported lost days owing to HAE attacks (44.7%). Fifty-eight attacks (17%) resulted in time away from work or school, equating to a total of 85.5 days lost. CONCLUSIONS This study was a first of its kind, real-world, prospective, observational study of Australian patients living with HAE. Despite the availability of effective on-demand therapies, HAE remains burdensome. Wider access to safe and effective prophylactic therapies is needed for patients living with HAE.
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Affiliation(s)
- Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia; Faculty of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
| | | | - Peter H Button
- McCloud Consulting Group, Sydney, New South Wales, Australia
| | | | - Pamela K Burton
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Fiona A Perram
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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Riedl MA, Danese M, Danese S, Ulloa J, Maetzel A, Audhya PK. Hereditary Angioedema With Normal C1 Inhibitor: US Survey of Prevalence and Provider Practice Patterns. J Allergy Clin Immunol Pract 2023; 11:2450-2456.e6. [PMID: 36720386 DOI: 10.1016/j.jaip.2023.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) with normal C1-INH (HAE-nl-C1INH) is phenotypically similar to HAE resulting from C1-INH deficiency (HAE-C1INH). Confirmatory diagnostic tests for HAE-nl-C1INH are limited and few clinical study data exist regarding management of the condition. Therefore, survey studies may provide initial estimates of prevalence, diagnosis, and management patterns of this condition. OBJECTIVE To estimate the prevalence and describe current management patterns for HAE-nl-C1INH in the United States (US). METHODS We conducted an Internet-based survey of US physicians to estimate the prevalence of the HAE-nl-C1INH population in the United States. Potential participating physicians were identified from the US Hereditary Angioedema Association database and IQVIA Xponent prescription database. Eligible physicians were invited to complete an online survey between June and September 2021. RESULTS A total of 113 physicians provided data for the estimation of HAE-nl-C1INH prevalence and 81 physicians treating HAE-nl-C1INH patients provided data about treatment patterns. In bias-corrected analysis, we estimated 1,230 to 1,331 HAE-nl-C1INH patients within the United States between May 2019 and April 2020. Mean time to diagnosis for HAE-nl-C1INH was approximately 6 years (range, 2.4-13.5 years). Response to medication was commonly used to inform diagnosis (antihistamine response or nonresponse used by 73% of physician respondents, corticosteroids by 57%, or HAE-specific medications by 74%), and Factor XII genetic testing was used by 43%. CONCLUSIONS These survey data provide estimates of HAE-nl-C1INH prevalence in the United States as well as current diagnosis and management strategies. Results may be useful for developing studies to assess treatment efficacy and safety, and potentially improve the diagnosis for and management of this patient population.
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Affiliation(s)
- Marc A Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, Calif.
| | | | | | | | - Andreas Maetzel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Fijen LM, Klein PCG, Cohn DM, Kanters TA. The Disease Burden and Societal Costs of Hereditary Angioedema. J Allergy Clin Immunol Pract 2023; 11:2468-2475.e2. [PMID: 36990433 DOI: 10.1016/j.jaip.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND According to the current treatment guidelines, the goals of treatment of patients with hereditary angioedema (HAE) are to achieve total control of the disease and to normalize patients' lives. OBJECTIVE This study aims to establish the entire burden of HAE comprising disease control, treatment satisfaction, reductions in quality of life, and societal costs. METHODS Adult patients with HAE under treatment at the Dutch national center of reference completed a cross-sectional survey in 2021. The survey consisted of different questionnaires: angioedema-specific questionnaires (4-week Angioedema Activity Score and Angioedema Control Test), quality of life questionnaires (Angioedema Quality of Life [AE-QoL] questionnaire and EQ-5D-5L), the Treatment Satisfaction Questionnaire for Medication (TSQM), and societal costs questionnaires (iMTA Medical Consumption Questionnaire and iMTA Productivity Cost Questionnaire). RESULTS The response rate was 78% (69 of 88). The entire sample had a mean Angioedema Activity Score of 16.61, and 36% of participants had poorly controlled disease as expressed by the Angioedema Control Test. The mean quality of life in the entire sample was 30.99 as expressed by the AE-QoL and 0.873 as expressed by the EQ-5D-5L utility value. Utilities dropped by 0.320 points during an angioedema attack. TSQM scores ranged from 66.67 to 75.00 across its 4 domains. On average, total costs per year incurred €22,764, predominantly existing of HAE-medication costs. Total costs showed substantial variation between patients. CONCLUSIONS This study describes the entire burden of HAE among Dutch patients comprising disease control, quality of life, treatment satisfaction, and societal costs. These results can inform cost-effectiveness analyses that can aid reimbursement decisions for HAE treatments.
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Affiliation(s)
- Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip C G Klein
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Bork K, Wulff K, Witzke G, Staubach P, Hardt J, Meinke P. Gene Mutations Linked to Hereditary Angioedema in Solitary Angioedema Patients With Normal C1 Inhibitor. J Allergy Clin Immunol Pract 2023; 11:2441-2449. [PMID: 36787826 DOI: 10.1016/j.jaip.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Chronic recurrent angioedema without wheals (CRA) with normal C1 inhibitor (C1-INH) that is unresponsive to antihistamines may involve patients with recurrent angioedema of unknown cause (ie, so-called non-histaminergic idiopathic angioedema) as well as patients with hereditary angioedema with normal C1-INH (HAEnCI) when HAEnCI occurs in only one family member. OBJECTIVE To identify patients with one of type of HAEnCI in a group of patients with CRA with normal C1-INH that was unresponsive to antihistamines. METHODS A total of 132 patients with CRA and normal C1-INH that was unresponsive to antihistamines underwent mutational and clinical analysis. The presence of hereditary angioedema-specific mutations in Factor XII, plasminogen, ANGPT1, KNG1, MYOF, and HS3ST6 genes was tested by Sanger sequencing. When an HAEnCI-causing mutation was identified, available asymptomatic relatives were genetically tested. RESULTS In 116 of 132 solitary patients with CRA (87.9%), none of the six HAEnCI-linked mutations could be found. Ten patients (7.6%) had the Factor XII mutation c.983C>A (p.T328K) and six (4.5%) the plasminogen mutation c.988A>G (p.K330E). Other mutations linked to HAEnCI were not found in this patient series. In the 16 families with HAEnCI, 11 asymptomatic carriers of one of the HAEnCI-linked mutations were identified. CONCLUSIONS A search for HAEnCI-linked mutations in patients with solitary CRA may lead to the detection of patients and families with HAEnCI. This is important because family members can be identified who are at risk for developing potentially life-threatening angioedema, although they were previously asymptomatic. Without genetic investigation, the risk for an HAEnCI would have remained undetected in these patients and asymptomatic relatives.
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Affiliation(s)
- Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Karin Wulff
- University Medicine, University, Greifswald, Germany
| | - Günther Witzke
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Jochen Hardt
- Department of Medical Psychology and Medical Sociology, Johannes Gutenberg University, Mainz, Germany
| | - Peter Meinke
- Friedrich-Baur-Institute, Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
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Herraez L, Álvarez Sala P, Mielgo R. Subcutaneous plasma-derived C1 inhibitor for long-term prophylaxis during pregnancy and breast-feeding in a patient with factor XII hereditary angioedema. J Allergy Clin Immunol Pract 2023; 11:2587-2588. [PMID: 37121510 DOI: 10.1016/j.jaip.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/22/2023] [Accepted: 04/08/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Lys Herraez
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain.
| | | | - Ruth Mielgo
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
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Betschel SD, Banerji A, Busse PJ, Cohn DM, Magerl M. Hereditary Angioedema: A Review of the Current and Evolving Treatment Landscape. J Allergy Clin Immunol Pract 2023; 11:2315-2325. [PMID: 37116793 DOI: 10.1016/j.jaip.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023]
Abstract
Hereditary angioedema (HAE) is a rare disease characterized by sudden and often unprovoked episodes of swelling that can be potentially life-threatening when it involves the upper airway. The treatment options for both acute episodes of HAE and LTP, used to minimize the frequency and severity of angioedema attacks, were limited historically to very few options, had considerable side effects, and/or had considerable burden of treatment. Fortunately, through the elucidation of the pathophysiology of HAE, the development of newer targeted therapies has been possible both for acute therapy and long-term prophylaxis and even more are on the horizon. Because of the rapid development of these therapies, it can be challenging for clinicians to keep abreast of newer and developing treatments for HAE. This review article will outline the current and potential future treatments for HAE. It will also highlight important considerations when treating special HAE patient populations including women and pediatric patients.
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Affiliation(s)
- Stephen D Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Aleena Banerji
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Mass.
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Danny M Cohn
- Department of Vascular Medicine, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
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Farkas H, Balla Z. A safety review of prophylaxis drugs for adolescent patients with hereditary angioedema. Expert Opin Drug Saf 2023; 22:549-561. [PMID: 37334624 DOI: 10.1080/14740338.2023.2226861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/14/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Hereditary angioedema (HAE) is characterized by recurrent subcutaneously and/or submucosally localized edematous swellings. The first symptoms often appear in childhood, and they may become more frequent and severe in puberty. Since the appearance of HAE attacks is unpredictable regarding the localization and the frequency, the attacks put a significant burden on the patients and crucially impacts their quality of life. AREAS COVERED This review article analyzes the safety data acquired from the clinical trials conducted with the currently available medicinal products for the prophylactic treatment of hereditary angioedema due to C1 inhibitor deficiency and the safety data of observatory studies based on clinical practice. A review of the published literature was conducted using the PubMed database, clinical trials from ClinicalTrials.gov, and abstracts published at scientific conferences. EXPERT OPINION The currently available therapeutic products have a good safety and efficiency profile and the international guidelines recommend them as first-line treatments. The choice should be made based on the evaluation of the availability and the preference of the patient.
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Affiliation(s)
- Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- HNO-Praxis Schaffhausen, Schaffhausen, Switzerland
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Medina I, Josviack D, Berardi A, Cavallo C, Chinigo M, Chorzepa G, Fueyo G, García M, Onetti C, Vázquez D. [Health related to quality life of patients with hereditary angioedema in Argentina. A multicenter study]. Rev Alerg Mex 2023; 70:64-71. [PMID: 37566769 DOI: 10.29262/ram.v70i2.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To describe health relaed quality of life in a cohort of stable adult outpatients with hereditary an-gioedema (HAE) with validated tools. METHODS An observational, cross-sectional, and descriptive study was performed, carried out in patients with hereditary angioedema, coming from the City of Buenos Aires and its provinces: Corrientes, Chubut, Entre Ríos and Santa Fe. The HAE-QoL and SF-12v2 health questionnaires were applied to assess the related quality of life. with health. RESULTS 100 patients were included; median age: 41.5 years (range: 18-77); 65% were female, and 79% had type 1 HAE. Asymptomatic, mild, moderate and severe cases accounted for 6, 29, 38, and 27% of participants, respectively. Seventeen percent of patients were receiving long-term prophylaxis. Icatibant was the most fre-quent treatment for acute episodes. All health domains SF-12v2 scores were lower than expected in general population, excepting "vitality" and "physical functioning". Total and all specific domains HAE-QoL scores were reduced. Differences between women and men and in every age-defined group were demonstrated for sev-eral specific domains. CONCLUSIONS Health relaed to quality life was notably reduced in Argentinean patients with HAE, when imple-menting the HAE.QoL, and SF-12v2 questionnaries. The need for multidisciplinary strategies approaching this complex disease is highlighted.
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Affiliation(s)
- Iris Medina
- Centro Médico Vitae, 9 de Julio, Buenos Aires, Argentina.
| | - Darío Josviack
- Instituto de Medicina Respiratoria, Rafaela, Santa Fe, Argentina
| | - Alejandro Berardi
- Instituto de Asma, Alergia y Enfermedades Respiratorias, Corrientes, Argentina
| | | | - Marcela Chinigo
- Hospital Interzonal Especializado de Agudos y Crónicos San Juan de Dios, La Plata, Argentina
| | | | | | | | - Cora Onetti
- Hospital General De Agudos José María Penna, Buenos Aires, Argentina
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Watt M, Malmenäs M, Romanus D, Haeussler K. Network meta-analysis for indirect comparison of lanadelumab and berotralstat for the treatment of hereditary angioedema. J Comp Eff Res 2023; 12:e220188. [PMID: 37218553 PMCID: PMC10402909 DOI: 10.57264/cer-2022-0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Aim: With no head-to-head studies comparing the effectiveness of lanadelumab and berotralstat for prevention of hereditary angioedema (HAE) attacks, this network meta-analysis (NMA) aimed to indirectly compare the effectiveness of these treatments. Materials & methods: The NMA, using the published data from Phase III trials, was performed using a frequentist weighted regression-based approach following Rücker et al. Efficacy outcomes of interest were HAE attack rate per 28 days and ≥90% reduction in monthly HAE attacks. Results & conclusion: In this NMA, lanadelumab 300 mg administered every 2 weeks or every 4 weeks was associated with statistically significantly higher effectiveness versus berotralstat 150 mg once daily (q.d.) or 110 mg q.d. for both efficacy outcomes assessed.
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Affiliation(s)
- Maureen Watt
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Dorothy Romanus
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
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Javaud N, Gobert D. Hereditary angioedema: is there a better future for treatment? Lancet 2023; 401:1054-1055. [PMID: 36868262 DOI: 10.1016/s0140-6736(23)00438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Nicolas Javaud
- Université Paris Cité, Urgences, AP-HP, Centre de référence des angiœdèmes à kinines, Hôpital Louis Mourier, 92700 Colombes, France.
| | - Delphine Gobert
- Sorbonne Université, Médecine Interne, AP-HP, Centre de référence des angiœdèmes à kinines, Hôpital Saint-Antoine, Paris, France
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Craig TJ, Reshef A, Li HH, Jacobs JS, Bernstein JA, Farkas H, Yang WH, Stroes ESG, Ohsawa I, Tachdjian R, Manning ME, Lumry WR, Saguer IM, Aygören-Pürsün E, Ritchie B, Sussman GL, Anderson J, Kawahata K, Suzuki Y, Staubach P, Treudler R, Feuersenger H, Glassman F, Jacobs I, Magerl M. Efficacy and safety of garadacimab, a factor XIIa inhibitor for hereditary angioedema prevention (VANGUARD): a global, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023; 401:1079-1090. [PMID: 36868261 DOI: 10.1016/s0140-6736(23)00350-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Hereditary angioedema is a rare and potentially life-threatening genetic disease that is associated with kallikrein-kinin system dysregulation. Garadacimab (CSL312), a novel, fully-human monoclonal antibody that inhibits activated factor XII (FXIIa), is being studied for the prevention of hereditary angioedema attacks. The aim of this study was to evaluate the efficacy and safety of once-monthly subcutaneous administrations of garadacimab as prophylaxis for hereditary angioedema. METHODS VANGUARD was a pivotal, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial that recruited patients (aged ≥12 years) with type I or type II hereditary angioedema across seven countries (Canada, Germany, Hungary, Israel, Japan, the Netherlands, and the USA). Eligible patients were randomly assigned (3:2) to receive garadacimab or placebo for 6 months (182 days) by an interactive response technology (IRT) system. Randomisation was stratified by age (≤17 years vs >17 years) and baseline attack rate (1 to <3 attacks per month vs ≥3 attacks per month) for the adult group. The randomisation list and code were kept by the IRT provider during the study, with no access by site staff and funding representatives. All patients and investigational site staff, and representatives from the funder (or their delegates) with direct interaction with the study sites or patients, were masked to treatment assignment in a double-blind fashion. Randomly assigned patients received a 400-mg loading dose of subcutaneous garadacimab as two 200-mg injections or volume-matched placebo on day 1 of the treatment period, followed by five additional self-administered (or caregiver-administered) monthly doses of 200-mg subcutaneous garadacimab or volume-matched placebo. The primary endpoint was the investigator-assessed time-normalised number of hereditary angioedema attacks (number of hereditary angioedema attacks per month) during the 6-month treatment period (day 1 to day 182). Safety was evaluated in patients who received at least one dose of garadacimab or placebo. The study is registered with the EU Clinical Trials Register, 2020-000570-25 and ClinicalTrials.gov, NCT04656418. FINDINGS Between Jan 27, 2021, and June 7, 2022, we screened 80 patients, 76 of whom were eligible to enter the run-in period of the study. Of 65 eligible patients with type I or type II hereditary angioedema, 39 were randomly assigned to garadacimab and 26 to placebo. One patient was randomly assigned in error and did not enter the treatment period (no dose of study drug received), resulting in 39 patients assigned to garadacimab and 25 patients assigned to placebo being included. 38 (59%) of 64 participants were female and 26 (41%) were male. 55 (86%) of 64 participants were White, six (9%) were Asian (Japanese), one (2%) was Black or African American, one (2%) was Native Hawaiian or Other Pacific Islander, and one (2%) was listed as other. During the 6-month treatment period (day 1 to day 182), the mean number of investigator-confirmed hereditary angioedema attacks per month was significantly lower in the garadacimab group (0·27, 95% CI 0·05 to 0·49) than in the placebo group (2·01, 1·44 to 2·57; p<0·0001), corresponding to a percentage difference in means of -87% (95% CI -96 to -58; p<0·0001). The median number of hereditary angioedema attacks per month was 0 (IQR 0·00-0·31) for garadacimab and 1·35 (1·00-3·20) for placebo. The most common treatment-emergent adverse events were upper-respiratory tract infections, nasopharyngitis, and headaches. FXIIa inhibition was not associated with an increased risk of bleeding or thromboembolic events. INTERPRETATION Monthly garadacimab administration significantly reduced hereditary angioedema attacks in patients aged 12 years and older compared with placebo and had a favourable safety profile. Our results support the use of garadacimab as a potential prophylactic therapy for the treatment of hereditary angioedema in adolescents and adults. FUNDING CSL Behring.
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Affiliation(s)
- Timothy J Craig
- Allergy, Asthma and Immunology, Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA.
| | - Avner Reshef
- Allergy, Immunology & Angioedema Center, Barzilai University Hospital, Ashkelon, Israel
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | | | - Jonathan A Bernstein
- University of Cincinnati, Department of Internal Medicine Division of Rheumatology, Allergy and Immunology and the Bernstein Clinical Research Center Cincinnati, Cincinnati, OH, USA
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - William H Yang
- Ottawa Allergy Research Corporation, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Isao Ohsawa
- Department of Nephrology, Saiyu Soka Hospital, Saitama, Japan
| | - Raffi Tachdjian
- Division of Allergy & Clinical Immunology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Michael E Manning
- Allergy, Asthma & Immunology Associates, Ltd, Internal Medicine, UA College of Medicine, Phoenix, Phoenix, AZ, USA
| | | | | | - Emel Aygören-Pürsün
- Klinikum der Johann Wolfgang-Goethe Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gordon L Sussman
- Gordon Sussman Clinical Research Inc and Department of Clinical Immunology and Allergy, St Michael's Hospital, Toronto, ON, Canada
| | | | - Kimito Kawahata
- St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Regina Treudler
- University Leipzig Medical Faculty, Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology-CAC, Leipzig, Germany
| | | | | | | | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Aygören-Pürsün E, Zanichelli A, Cohn DM, Cancian M, Hakl R, Kinaciyan T, Magerl M, Martinez-Saguer I, Stobiecki M, Farkas H, Kiani-Alikhan S, Grivcheva-Panovska V, Bernstein JA, Li HH, Longhurst HJ, Audhya PK, Smith MD, Yea CM, Maetzel A, Lee DK, Feener EP, Gower R, Lumry WR, Banerji A, Riedl MA, Maurer M. An investigational oral plasma kallikrein inhibitor for on-demand treatment of hereditary angioedema: a two-part, randomised, double-blind, placebo-controlled, crossover phase 2 trial. Lancet 2023; 401:458-469. [PMID: 36774155 DOI: 10.1016/s0140-6736(22)02406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Guidelines recommend effective on-demand therapy for all individuals with hereditary angioedema. We aimed to assess the novel oral plasma kallikrein inhibitor, sebetralstat, which is in development, for on-demand treatment of hereditary angioedema attacks. METHODS In this two-part phase 2 trial, individuals with type 1 or 2 hereditary angioedema aged 18 years or older were recruited from 25 sites, consisting of specialty outpatient centres, across nine countries in Europe and the USA. Individuals were eligible if they had experienced at least three hereditary angioedema attacks in the past 93 days, were not on prophylactic therapy, and had access to and the ability to self-administer conventional attack treatment. In part 1 of the trial, participants were given a single 600 mg open-label oral dose of sebetralstat to assess safety, pharmacokinetics, and pharmacodynamics of the dose. Part 2 was a randomised, double-blind, placebo-controlled, two-sequence, two-period (2 × 2) crossover trial; participants were randomly assigned (1:1) to either sequence 1, in which they were given a single dose of 600 mg of sebetralstat to treat the first eligible attack and a second dose of placebo to treat the second eligible attack, or sequence 2, in which they were given placebo to treat the first eligible attack and then 600 mg of sebetralstat to treat the second eligible attack. Participants and investigators were masked to treatment assignment. The primary endpoint was time to use of conventional attack treatment within 12 h of study drug administration, which was assessed in all participants who were randomly assigned to treatment and who received study drug for two attacks during part 2 of the study. Safety was assessed in all participants who received at least one dose of study drug, starting in part 1. This study is registered with ClinicalTrials.gov, NCT04208412, and is completed. FINDINGS Between July 2, 2019, and Dec 8, 2020, 84 individuals were screened and 68 were enrolled in part 1 and received sebetralstat (mean age 38·3 years [SD 13·2], 37 [54%] were female, 31 [46%] were male, 68 [100%] were White). 42 (62%) of 68 participants completed pharmacokinetic assessments. Sebetralstat was rapidly absorbed, with a geometric mean plasma concentration of 501 ng/mL at 15 min. In a subset of participants (n=6), plasma samples obtained from 15 min to 4 h after study drug administration had near-complete protection from ex vivo stimulated generation of plasma kallikrein and cleavage of high-molecular-weight kininogen. In part 2, all 68 participants were randomly assigned to sequence 1 (n=34) or sequence 2 (n=34). 53 (78%) of 68 participants treated two attacks (25 [74%] in the sequence 1 group and 28 [82%] in the sequence 2 group). Time to use of conventional treatment within 12 h of study drug administration was significantly longer with sebetralstat versus placebo (at quartile 1: >12 h [95% CI 9·6 to >12] vs 8·0 h [3·8 to >12]; p=0·0010). There were no serious adverse events or adverse event-related discontinuations. INTERPRETATION Oral administration of sebetralstat was well tolerated and led to rapid suppression of plasma kallikrein activity, resulting in increased time to use of conventional attack treatment and faster symptom relief versus placebo. Based on these results, a phase 3 trial to evaluate the efficacy and safety of two dose levels of sebetralstat in adolescent and adult participants with hereditary angioedema has been initiated (NCT05259917). FUNDING KalVista Pharmaceuticals.
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Affiliation(s)
- Emel Aygören-Pürsün
- Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt, Germany
| | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Operative Unit of Medicine, IRCCS Policlinico San Donato, Milan, Italy
| | - Danny M Cohn
- Amsterdam UMC, Department of Vascular Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Roman Hakl
- Department of Clinical Immunology and Allergology, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Markus Magerl
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Sorena Kiani-Alikhan
- Barts Health NHS Trust, Department of Immunology, GA(2)LEN/HAEi Angioedema Centre of Reference and Excellence, London, UK
| | - Vesna Grivcheva-Panovska
- PHI University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodius, Skopje, North Macedonia
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati, OH, USA
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | - Hilary J Longhurst
- Department of Immunology, Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | | | | | | | - Andreas Maetzel
- KalVista Pharmaceuticals, Cambridge, MA, USA; Institute of Health Policy, Management & Evaluation, University of Toronto, ON, Canada
| | | | | | | | | | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, USA
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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