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Mazzoccanti G, Manetto S, Bassan M, Macis M, Cabri W, Ciogli A, Ricci A, Gasparrini F. Assessing the performance of new chromatographic technologies for the separation of peptide epimeric impurities: the case of Icatibant. Eur J Pharm Sci 2024; 193:106682. [PMID: 38142950 DOI: 10.1016/j.ejps.2023.106682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Abstract
The biopharmaceutical industry faces the challenge of efficiently characterising impurity profiles of therapeutical peptides, also due to their complex polar and ionisable attributes. This research explores the potential of advanced chromatographic techniques to address this challenge. The study compares dynamic electrostatic repulsion reversed phase (d-ERRP) to its counterparts (static ERRP and ion pair reversed phase IP-RP) in analysing Icatibant and its elusive epimeric impurity, [L-Arg]1-Icatibant and highlights its exceptional capabilities in generating symmetric peaks, mitigating the common tailing phenomenon, and serving as a steadfast guardian of column longevity. The result highlights d-ERRP as a pioneering tool in the domain of liquid chromatography, fostering its role as a reference technique for the analysis of therapeutic peptides.
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Affiliation(s)
- Giulia Mazzoccanti
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Simone Manetto
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Michele Bassan
- Fresenius Kabi iPSUM, Via Roma 108, 20051 Cassina de Pecchi, Italy
| | - Marco Macis
- Fresenius Kabi iPSUM, Via Roma 108, 20051 Cassina de Pecchi, Italy
| | - Walter Cabri
- Department of Chemistry, Alma Mater Studiorum-University of Bologna, Via Gobetti 84, 40129 Bologna, Italy
| | - Alessia Ciogli
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Antonio Ricci
- Fresenius Kabi iPSUM, Via Roma 108, 20051 Cassina de Pecchi, Italy.
| | - Francesco Gasparrini
- Department of Drug Chemistry and Technology, "Sapienza" University of Rome, 00185 Rome, Italy.
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Martinez-Saguer I, Bork K, Latysheva T, Zabrodska L, Chopyak V, Nenasheva N, Totolyan A, Krivenchuk V. Plasma-derived C1 esterase inhibitor pharmacokinetics and safety in patients with hereditary angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100178. [PMID: 38033485 PMCID: PMC10684372 DOI: 10.1016/j.jacig.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 12/02/2023]
Abstract
Background Over 40 years of use demonstrates that complement 1 esterase inhibitor (C1-INH) concentrate is effective and well tolerated for acute edema attacks and prophylaxis in patients with hereditary angioedema. OCTA-C1-INH is a new stable, virus-inactivated, nanofiltrated concentrate of C1-INH derived from human plasma. Objective We investigated the pharmacokinetics and safety profile of new C1-INH in people with hereditary angioedema during an attack-free period. Methods In this prospective, multicenter, open-label, single-arm study, adults with hereditary angioedema type I/II received a single intravenous dose of 20 IU/kg C1-INH. Blood samples were taken ≤30 minutes before infusion, and 0, 0.25, 1, 2, 6, 12, 24, 48, 72, 120, 144, and 168 hours after infusion. The primary end point was assessing the pharmacokinetic parameters of C1-INH measured by C1-INH activity. Safety end points were also examined. Results Twenty patients received a single dose of 20 IU/kg new C1-INH with a mean (standard deviation) total dose of 1457.3 (356.51) IU. Mean (standard deviation) area under the curve normalized by dose was 51.6 (17.9) h∙IU/mL/IU, maximum blood concentration was 1.14 (0.989) IU/mL, incremental recovery was 0.0466 (0.051) (IU∙kg)/(IU∙mL), half-life was 0.598 (0.716) hours, and time to maximum concentration was 0.598 (0.716) hours. No thromboembolic events were recorded. No treatment-emergent adverse events were rated as severe/serious. Conclusion PK parameters of new C1-INH were in line with those reported for other C1-INH concentrates. New C1-INH demonstrated a favorable safety profile in patients with C1-INH deficiency. Further studies are warranted to determine the effectiveness and longer-term safety of new C1-INH.
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Affiliation(s)
| | - Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Tatiana Latysheva
- Federal State Budget Institution “National Research Center Institute of Immunology” of FMBA of Russia, Moscow, Russia
| | - Liudmyla Zabrodska
- SI Institute of Otolaryngology na Prof O. S. Kolomiychenko of NAMS of Ukraine, Center of Allergic Diseases, Kyiv, Ukraine
| | - Valentyna Chopyak
- Municipal Non-commercial Enterprise of Lviv Regional Council “Lviv Regional Clinical Hospital” Rheumatology Department, Lviv, Ukraine
| | - Natalia Nenasheva
- Federal State Budget Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Postgraduate Education” of Ministry of Healthcare of Russian Federation, Department of Clinical Allergology, Moscow, Russia
| | - Areg Totolyan
- Federal Budget Institution of Science “Saint Petersburg Scientific Research Institute of Epidemiology and Microbiology named after Pasteur” of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Saint Petersburg, Russia
| | - Vitaliy Krivenchuk
- State Institution “Republican Research and Applied Center for Medical Radiology and Human Ecology”, Gomel, Republic of Belarus
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Prenzel F, Abraham S, Hirche C, Müller G, Kaiser S, Serdani‐Neuhaus L, Zingel R, Martinez‐Saguer I. Epidemiology and treatment of children with hereditary angioedema in Germany: A retrospective database study. Clin Transl Allergy 2023; 13:e12313. [PMID: 38006382 PMCID: PMC10642561 DOI: 10.1002/clt2.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/11/2023] [Accepted: 10/26/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is a potentially life-threatening inherited disease that causes recurrent, serious, and debilitating episodes of swelling. While evidence has improved in adult patients, data on the epidemiology and treatment of pediatric patients with HAE remain very limited. The aim of this study was to determine the incidence and prevalence of pediatric patients with HAE aged <12 years, as well as treatment patterns, co-medication, and specialties involved. METHODS In this retrospective study (2016-2021), the German IQVIATM pharmacy claims (LRx) database was used to analyze prescriptions of HAE-specific treatments and co-medications. RESULTS We found an HAE prevalence in pediatric patients aged <12 years of 2.51:100,000 and a 12-month prevalence of up to 1.02:100,000 between 2016 and 2021. Most HAE treatments were prescribed by outpatient clinics and pediatricians, with an increasing proportion of icatibant as an on-demand treatment and low rates of long-term prophylaxis (LTP). The prescription rate of analgesics as the most common co-medication decreased notably after HAE diagnosis. CONCLUSION Our findings provide insights into the epidemiology and current pediatric HAE treatment landscape in Germany. The obtained HAE prevalence in pediatric patients aged <12 years was even higher than the previously reported average of overall cohorts, whereas the LTP rate was low, which might indicate an unmet need for newer LTP treatment options in pediatric patients.
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Affiliation(s)
- Freerk Prenzel
- Department of PediatricsUniversity of Leipzig Medical CenterLeipzigGermany
| | - Susanne Abraham
- Department of DermatologyUniversity Allergy CenterUniversity Hospital Carl Gustav CarusTU DresdenGermany
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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. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 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] [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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Rajaram Mohan K, Chinnakutti S, Murugesan D, Govind Raj S, Ganesan RK. Angioedema of Vermilion Border Lip: A Case Report. Cureus 2022; 14:e30142. [DOI: 10.7759/cureus.30142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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Muacevic A, Adler JR, Gregory GE, Ghaly M, Case J. The Interplay of COVID-19 and Hereditary Angioedema: Preventing an Acute Attack. Cureus 2022; 14:e29189. [PMID: 36507113 PMCID: PMC9731548 DOI: 10.7759/cureus.29189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare inherited disease that is caused by the inactivation of the C1 esterase inhibitor. In this case report, we present a 51-year-old female previously diagnosed with HAE who tested positive for SARS-Cov-2 (COVID-19). The patient was treated symptomatically. Dexamethasone was used to treat COVID-19 pneumonia. Broad-spectrum antibiotics (vancomycin and meropenem) were utilized to prevent future infection. Although the patient did not experience an acute angioedema attack during her hospital stay, the patient expired due to the exacerbation of COVID-19 pneumonia.
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Lo SH, Lloyd A, Elkhalifa S, Sisic Z, van Nooten FE. Time Trade-Off Utilities for Hereditary Angioedema Health and Caregiver States. PHARMACOECONOMICS - OPEN 2022; 6:231-239. [PMID: 34532843 PMCID: PMC8864034 DOI: 10.1007/s41669-021-00302-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is an inherited chronic rare disease characterised by recurrent swelling attacks that are associated with significant physical and psychological burden. There is limited understanding of the effect of attack location on this burden and of caregiver burden. OBJECTIVE Our objective was to capture the relative burden of HAE health and caregiver states, including different attack locations, through a time trade-off (TTO) analysis involving participants from the general public. METHODS Qualitative interviews were undertaken to inform vignette development for the TTO study, including vignettes for abdominal, facial, hand and laryngeal attack health states, and an attack-free and caregiver state. Members of the general public in England rated vignettes in TTO interviews, which included a visual analogue scale (VAS) component. For the development of the health state vignettes, qualitative interviews with 15 patients, 5 caregivers and 1 clinical expert were performed. TTO analysis was based on vignette valuation completed by 100 members of the general public. RESULTS The TTO values were as follows: attack-free, 0.783 (standard deviation [SD] 0.316); hand: 0.582 (SD 0.380); facial: 0.483 (SD 0.448); abdominal: 0.345 (SD 0.458); and laryngeal: 0.128 (SD 0.529). The caregiver rating was 0.762 (SD 0.303). V' scores were similar and consistent with TTO values. CONCLUSION TTO utility values demonstrate that HAE places a significant burden on patients, which is influenced by attack location, and on caregivers. These utility weights can provide important information on quality of life for future economic evaluations of treatments.
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Affiliation(s)
| | | | - Shuayb Elkhalifa
- Salford Royal NHS Foundation Trust and University of Manchester, Manchester, UK
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Maurer M, Magerl M, Aygören-Pürsün E, Bork K, Farkas H, Longhurst H, Kiani-Alikhan S, Bouillet L, Boccon-Gibod I, Cancian M, Zanichelli A, Launay D. Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:4. [PMID: 35027083 PMCID: PMC8759255 DOI: 10.1186/s13223-021-00644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00644-0.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany.
| | - Markus Magerl
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany
| | | | - Konrad Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | - Henriette Farkas
- Hungarian Angioedema Center of Excellence and Reference (ACARE), Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Hilary Longhurst
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | - Sorena Kiani-Alikhan
- Angioedema Center of Reference and Excellence (ACARE), Barts Health NHS Trust, London, UK
| | - Laurence Bouillet
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Boccon-Gibod
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Mauro Cancian
- Italian Network for Hereditary and Acquired Angioedema (ITACA), Interregional Center of Reference for Angioedema, University of Padova, Padova, Italy
| | - Andrea Zanichelli
- Italian National Center of Reference for Angiodema, Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco - Università degli Studi di Milano, Milan, Italy
| | - David Launay
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, French National Center of Reference for Angioedema, 59000, Lille, France
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Cui Q, Xu Q, Yang Y, Li W, Huang N, Chen H, Ma D, Zhang S, Yang L, Zhu R. The prevalence of hereditary angioedema in a Chinese cohort with decreased complement 4 levels. World Allergy Organ J 2022; 15:100620. [PMID: 34992711 PMCID: PMC8693024 DOI: 10.1016/j.waojou.2021.100620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Hereditary angioedema (HAE) is a rare, life-threatening autosomal dominant disorder. We aimed to investigate the prevalence of HAE in a Chinese population with a decreased Complement 4 (C4) level. Methods All the patients present in Tongji Hospital with C4 below lower normal range were included from January 2019 to June 2020. The individual data were extracted from the database and categorized by diagnosis. Patients suspected of HAE were further evaluated by C1 inhibitor level and function test to confirm the HAE diagnosis. Results A total of 8226 patients were enrolled in our study, among whom 18 had symptoms similar to HAE and received C1 inhibitor level and function tests. Two (1 male and 1 female) of the 18 patients were identified as HAE patients. This means the prevalence of HAE was 2.43/10 000 among the C4-decreased population and 10.1/10 000 in the C4-decreased population with etiology undetermined. The 2 HAE patients had experienced skin and oropharynx edema attack and received tracheotomy. The female patient had a family history. Laboratory tests showed significant decrease of C4 and C1 inhibitor levels in the 2 patients, both of whom were diagnosed as type 1 HAE. Conclusion The prevalence of HAE is low in C4-decreased patients. In a large cohort, C4 level can serve as a practical indicator to screen the HAE patients, but further testing of C1 inhibitor activity and levels is needed to confirm the diagnosis of HAE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rongfei Zhu
- Corresponding author. Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Santacroce R, D’Andrea G, Maffione AB, Margaglione M, d’Apolito M. The Genetics of Hereditary Angioedema: A Review. J Clin Med 2021; 10:jcm10092023. [PMID: 34065094 PMCID: PMC8125999 DOI: 10.3390/jcm10092023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Hereditary angioedema is a rare inherited disorder characterized by recurrent episodes of the accumulation of fluids outside of the blood vessels, causing rapid swelling of tissues in the hands, feet, limbs, face, intestinal tract, or airway. Mutations in SERPING1, the gene that encodes C1-INH (C1 esterase inhibitor), are responsible for the majority of cases of hereditary angioedema. C1 esterase inhibitor (C1-INH) is a major regulator of critical enzymes that are implicated in the cascades of bradykinin generation, which increases the vascular permeability and allows the flow of fluids into the extracellular space and results in angioedema. Moreover, a dominantly inherited disease has been described that has a similar clinical picture to C1-INH-HAE (Hereditary angioedema due to C1 inhibitor deficiency), but with normal C1-INH level and activity. This new type of HAE has no mutation in the SERPING1 gene and it is classified as nC1-INH-HAE (HAE with normal C1-INH). Currently mutations in six different genes have been identified as causing nC1-INH-HAE: factor XII (F12), plasminogen (PLG), angiopoietin 1 (ANGPT1), Kininogen 1 (KNG1), Myoferlin (MYOF), and heparan sulfate (HS)-glucosamine 3-O-sulfotransferase 6 (HS3ST6). In this review we aim to summarize the recent advances in genetic characterization of angioedema and possible future prospects in the identification of new genetic defects in HAE. We also provide an overview of diagnostic applications of genetic biomarkers using NGS technologies (Next Generation Sequencing).
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Affiliation(s)
- Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (R.S.); (G.D.); (M.M.)
| | - Giovanna D’Andrea
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (R.S.); (G.D.); (M.M.)
| | - Angela Bruna Maffione
- Human Anatomy, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (R.S.); (G.D.); (M.M.)
| | - Maria d’Apolito
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (R.S.); (G.D.); (M.M.)
- Correspondence:
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Geba D, Mohd Sani J, Gascon M, Hahn R, Aggarwal K, Rosselli J. Hereditary angioedema patients would prefer newer-generation oral prophylaxis. J Drug Assess 2021; 10:51-56. [PMID: 33489436 PMCID: PMC7801100 DOI: 10.1080/21556660.2020.1863699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To explore treatment preferences of patients with Hereditary Angioedema (HAE), a debilitating disorder characterized by potentially life-threatening, recurrent episodes of swelling, resulting in significant physical, emotional, and economic burden. With newer oral prophylactic treatments on the horizon, it is important to understand patients’ preferences. Methods An online survey was conducted in 2018 among United States (US) adult patients diagnosed with Type I or II HAE. Respondents were recruited anonymously from online panels and social media. Results Online surveys were completed by 75 patients diagnosed with HAE by a healthcare provider, with a mean of 16.7 years since diagnosis. Most patients (64%) report taking at least one medication for prophylaxis of HAE attacks. While almost all patients surveyed agree it is important to take preventative medication as prescribed, over half (52%) of patients report HAE prophylactic treatment to be burdensome. Despite stating that they like their current medications, 98% of the prophylactic HAE medication users would prefer an oral treatment if available; almost all (96%) prophylaxis users agree that oral preventative medication would fit their life better than an injectable medication, with 67% of users citing convenience as the primary reason to try an oral preventative HAE medication. If a more convenient option were available, nearly all (96%) patients currently not treating their HAE prophylactically would feel encouraged to do so. Conclusions Most patients with HAE would prefer a newer generation oral prophylactic medication that would decrease treatment burden and allow them to live fuller lives.
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Wang Y, Jomphe C, Marier JF, Martin P. Population Pharmacokinetics and Exposure-Response Analyses to Guide Dosing of Icatibant in Pediatric Patients With Hereditary Angioedema. J Clin Pharmacol 2020; 61:555-564. [PMID: 33091166 PMCID: PMC7984404 DOI: 10.1002/jcph.1768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
Elevated bradykinin levels are responsible for the development of clinical symptoms in patients with hereditary angioedema (HAE). Icatibant is a bradykinin type 2 receptor antagonist indicated for the acute treatment of HAE attacks. A population modeling and simulation approach was used to examine sources of variability impacting icatibant pharmacokinetics (PK) and provide guidance on icatibant dosing in pediatric patients with HAE. An exposure‐response analysis was performed for the time to onset of symptom relief (TOSR). Data from 141 adults (133 healthy, 8 with HAE) who received subcutaneous icatibant 30 mg and 31 pediatric patients with HAE who received 0.4 mg/kg (capped at 30 mg) were included in the analysis. Icatibant PK was described by a 2‐compartment model with linear elimination. Complete absorption of icatibant was expected within 1 hour of dosing. The apparent clearance and central volume of distribution were 15.4 L/h and 20.4 L, respectively. Icatibant PK was mainly dependent on body weight. The mean TOSR was very short (1.38 hours). A flat exposure‐response was observed, confirming that the relationship plateaued at the level of exposure observed in pediatric patients. Simulations confirmed that weight band–based dosing regimens (10 mg [12‐25 kg], 15 mg [26‐40 kg], 20 mg [41‐50 kg], 25 mg [51‐65 kg], and 30 mg [>65 kg]) resulted in exposure similar to the 0.4‐mg/kg dose. This analysis showed that icatibant undergoes rapid absorption, reaches levels required for therapeutic response, and promptly relieves HAE symptoms. A weight band–based dosing regimen is appropriate in pediatric patients with HAE.
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Affiliation(s)
- Yi Wang
- Takeda Pharmaceutical Company Limited, Lexington, Massachusetts, USA
| | - Claudia Jomphe
- Certara Strategic Consulting, Princeton, New Jersey, USA
| | | | - Patrick Martin
- Takeda Pharmaceutical Company Limited, Lexington, Massachusetts, USA
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Banday AZ, Kaur A, Jindal AK, Rawat A, Singh S. An update on the genetics and pathogenesis of hereditary angioedema. Genes Dis 2020; 7:75-83. [PMID: 32181278 PMCID: PMC7063419 DOI: 10.1016/j.gendis.2019.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 12/04/2022] Open
Abstract
Hereditary angioedema (HAE) is an uncommon genetic disorder characterized by recurrent episodes of edema involving subcutaneous tissue and submucosa. The pathogenesis of HAE reflects an intricate coordinated regulation of components of complement, kinin and hemostatic pathway. Till date, mutations in 4 different genes have been identified to cause HAE which includes serine protease inhibitor G1 (SERPING1), factor XII (F12), plasminogen (PLG) and angiopoietin 1 (ANGPT 1). These mutations lead to increased bradykinin 2 receptor mediated signalling via increased production of bradykinin except mutations in ANGPT1 gene that disturbs the cytoskeletal assembly of vascular endothelial cells. In this review we aim to summarize the recent advances in the pathogenesis and genetics of HAE. We also provide an overview of possible future prospects in the identification of new genetic defects in HAE.
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Affiliation(s)
| | | | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rachdi M, Waku J, Hazgui H, Demongeot J. Entropy as a Robustness Marker in Genetic Regulatory Networks. ENTROPY 2020; 22:e22030260. [PMID: 33286034 PMCID: PMC7516706 DOI: 10.3390/e22030260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
Genetic regulatory networks have evolved by complexifying their control systems with numerous effectors (inhibitors and activators). That is, for example, the case for the double inhibition by microRNAs and circular RNAs, which introduce a ubiquitous double brake control reducing in general the number of attractors of the complex genetic networks (e.g., by destroying positive regulation circuits), in which complexity indices are the number of nodes, their connectivity, the number of strong connected components and the size of their interaction graph. The stability and robustness of the networks correspond to their ability to respectively recover from dynamical and structural disturbances the same asymptotic trajectories, and hence the same number and nature of their attractors. The complexity of the dynamics is quantified here using the notion of attractor entropy: it describes the way the invariant measure of the dynamics is spread over the state space. The stability (robustness) is characterized by the rate at which the system returns to its equilibrium trajectories (invariant measure) after a dynamical (structural) perturbation. The mathematical relationships between the indices of complexity, stability and robustness are presented in case of Markov chains related to threshold Boolean random regulatory networks updated with a Hopfield-like rule. The entropy of the invariant measure of a network as well as the Kolmogorov-Sinaï entropy of the Markov transition matrix ruling its random dynamics can be considered complexity, stability and robustness indices; and it is possible to exploit the links between these notions to characterize the resilience of a biological system with respect to endogenous or exogenous perturbations. The example of the genetic network controlling the kinin-kallikrein system involved in a pathology called angioedema shows the practical interest of the present approach of the complexity and robustness in two cases, its physiological normal and pathological, abnormal, dynamical behaviors.
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Affiliation(s)
- Mustapha Rachdi
- Team AGIM (Autonomy, Gerontechnology, Imaging, Modelling & Tools for e-Gnosis Medical), Laboratory AGEIS, EA 7407, University Grenoble Alpes, Faculty of Medicine, 38700 La Tronche, France; (M.R.); (H.H.)
| | - Jules Waku
- LIRIMA-UMMISCO, Université de Yaoundé, Faculté des Sciences, BP 812 Yaoundé, Cameroun;
| | - Hana Hazgui
- Team AGIM (Autonomy, Gerontechnology, Imaging, Modelling & Tools for e-Gnosis Medical), Laboratory AGEIS, EA 7407, University Grenoble Alpes, Faculty of Medicine, 38700 La Tronche, France; (M.R.); (H.H.)
| | - Jacques Demongeot
- Team AGIM (Autonomy, Gerontechnology, Imaging, Modelling & Tools for e-Gnosis Medical), Laboratory AGEIS, EA 7407, University Grenoble Alpes, Faculty of Medicine, 38700 La Tronche, France; (M.R.); (H.H.)
- Correspondence:
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Piras V, Alves F, Gonçalo M. Self‐administration of icatibant in acute attacks of Type I hereditary angioedema: A case report and review of hereditary angioedema. Dermatol Ther 2019; 32:e13098. [DOI: 10.1111/dth.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Viviana Piras
- Department of Medical Sciences and Public Health, Unit of DermatologyUniversity of Cagliari Cagliari Italy
| | - Francisca Alves
- Department of DermatologyUniversity Hospital of Coimbra Coimbra Portugal
| | - Margarida Gonçalo
- Department of DermatologyUniversity Hospital of Coimbra Coimbra Portugal
- Department of Dermatology, Faculty of MedicineUniversity of Coimbra Coimbra Portugal
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Bygum A, Caballero T, Grumach AS, Longhurst HJ, Bouillet L, Aberer W, Zanichelli A, Botha J, Andresen I, Maurer M. Elderly versus younger patients with hereditary angioedema type I/II: patient characteristics and safety analysis from the Icatibant Outcome Survey. Clin Transl Allergy 2019; 9:37. [PMID: 31360439 PMCID: PMC6639901 DOI: 10.1186/s13601-019-0272-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) is characterized by recurrent swelling in subcutaneous or submucosal tissues. Symptoms often begin by age 5-11 years and worsen during puberty, but attacks can occur at any age and recur throughout life. Disease course in elderly patients is rarely reported. Methods The Icatibant Outcome Survey (IOS) is an observational study evaluating the safety, tolerability, and efficacy of icatibant. We conducted descriptive analyses in younger (age < 65 years) versus elderly patients (age ≥ 65 years). Here, we report patient characteristics and safety-related findings. Results As of February 2018, 872 patients with C1-INH-HAE type I/II were enrolled, of whom 100 (11.5%) were ≥ 65 years old. Significant differences between elderly versus younger patients, respectively, were noted for median age at symptom onset (17.0 vs 12.0 years), age at diagnosis (41.0 vs 19.4 years), and delay between symptom onset and diagnosis (23.9 vs 4.8 years) (P ≤ 0.0001 for all). Median age at diagnosis was significantly higher in elderly patients regardless of family history (P < 0.0001). Throughout the study, icatibant was used to treat 6798 attacks in 574 patients, with 63 elderly patients reporting 715 (10.5%) of the icatibant-treated attacks. No serious adverse events (SAEs) in elderly patients were judged to be possibly related to icatibant, whereas two younger patients reported three possibly related SAEs. Excluding off-label use and pregnancy (evaluated for regulatory purposes), the percentage of patients with at least one possibly/probably related AE was similar for elderly (2.0%) versus younger patients (2.7%). No deaths linked to icatibant treatment were identified. All related events in elderly patients were attributed to general disorders/administration site conditions, whereas related events in younger patients occurred across various system organ class designations. Conclusions Elderly patients with C1-INH-HAE were significantly older at diagnosis and had greater delay in diagnosis than younger patients. Elderly patients contributed to approximately 10% of the icatibant-treated attacks. Our analysis found similar AE rates (overall and possibly/probably related) in icatibant-treated elderly versus younger patients, despite the fact that elderly patients had significantly more comorbidities and were receiving a greater number of concomitant medications. Our analysis did not identify any new or unexpected safety concerns.
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Affiliation(s)
- Anette Bygum
- 1Department of Dermatology and Allergy Centre, Odense University Hospital, J.B. Winsløws Vej 4, Indgang 142, 5000 Odense C, Denmark.,2Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Teresa Caballero
- 3Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | | | - Hilary J Longhurst
- 5Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Laurence Bouillet
- 6National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Werner Aberer
- 7Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Andrea Zanichelli
- 8Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Jaco Botha
- 9Shire, a Takeda company, Zug, Switzerland
| | | | - Marcus Maurer
- 10Department of Dermatology and Allergy, Dermatological Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Busse PJ, Farkas H, Banerji A, Lumry WR, Longhurst HJ, Sexton DJ, Riedl MA. Lanadelumab for the Prophylactic Treatment of Hereditary Angioedema with C1 Inhibitor Deficiency: A Review of Preclinical and Phase I Studies. BioDrugs 2019; 33:33-43. [PMID: 30539362 PMCID: PMC6373397 DOI: 10.1007/s40259-018-0325-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hereditary angioedema (HAE) with C1 esterase inhibitor (C1-INH) deficiency (C1-INH-HAE) is a rare disease characterized by diminished levels or dysfunctional activity of C1-INH, leading to dysregulated plasma kallikrein activity within the kallikrein-kinin pathway. Symptoms manifest as painful, potentially life-threatening swelling of subcutaneous tissues throughout the body and/or submucosal edema in the upper airway or gastrointestinal tract. Attacks recur with unpredictable frequency, intensity, and duration, placing a heavy burden on patients' daily lives. Despite improved availability of medications for on-demand treatment during attacks and prophylaxis of future attacks, unmet needs remain. Lanadelumab, a fully human monoclonal antibody, may help address some of the limitations of existing prophylactic options (e.g., the need for intravenous administration or frequent dosing). Preclinical studies demonstrate that it is highly potent and specifically inhibits plasma kallikrein, and findings from phase Ia and Ib studies suggest this agent is well tolerated and provides sustained inhibition of plasma kallikrein, allowing for less frequent dosing. The phase III HELP Study (NCT02586805) evaluating the efficacy and safety of lanadelumab in preventing HAE attacks has been completed, and its open-label extension (NCT02741596) is ongoing. Lanadelumab is now approved in the USA and Canada for prophylaxis to prevent attacks of HAE in patients aged ≥ 12 years. This review provides an overview of the discovery and clinical development of lanadelumab, from preclinical through phase Ib studies, characterizing its safety/tolerability, efficacy, and pharmacokinetic and pharmacodynamic profiles. It also highlights how this agent may positively impact clinical care of patients with C1-INH-HAE.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Angioedemas, Hereditary/drug therapy
- Angioedemas, Hereditary/pathology
- Angioedemas, Hereditary/physiopathology
- Angioedemas, Hereditary/prevention & control
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Clinical Trials, Phase I as Topic
- Drug Evaluation, Preclinical
- Humans
- Middle Aged
- Plasma Kallikrein/antagonists & inhibitors
- Plasma Kallikrein/drug effects
- Young Adult
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Affiliation(s)
- Paula J Busse
- Division of Clinical Immunology and Allergy, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room 11-20, New York, NY, 10029, USA.
| | - Henriette Farkas
- Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, Budapest, 1125, Hungary
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Cox 201, Boston, MA, 02114, USA
| | - William R Lumry
- Allergy and Asthma Research Associates, 10100 N. Central Expressway, Suite 100, Dallas, TX, 75231, USA
| | - Hilary J Longhurst
- Department of Immunology, Addenbrookes Hospital Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | | | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, 8899 University Center Lane, Suite 230, San Diego, CA, 92122, USA
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Spanò R, Di Paola N, Bova M, Barbarino A. Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema. BMC Health Serv Res 2018; 18:571. [PMID: 30029666 PMCID: PMC6053759 DOI: 10.1186/s12913-018-3389-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/13/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Our research focuses on the co-creation of value in healthcare with reference to a case of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE). Our work is mainly based on the concept of value co-creation in healthcare. The aim of this study is to assess the impact of an alternative treatment strategy - self-administration - by focusing on treatment outcomes and costs to understand if innovative therapeutic solutions can create value for patients and healthcare systems. METHODS This paper compares home-based and hospital-based therapeutic strategies (independent of treatment type) with a cost minimization analysis. It encompasses compliance issues and focuses on both payer and societal perspectives, also benefiting from an operationalization of the service-dominant logic model for healthcare delivery. Data were collected over a 6-month period (August 2014-January 2015) through monthly patient interviews. Archival data were used for variable measurement. RESULTS Thirty-nine out of 62 patients enrolled in the study, experienced at least one HAE attacks, equally distributed between home and hospital-based strategies. No evidence of correlation between therapeutic strategy and disease severity score (p = 0.351), compliance (p = 0.399), and quality of life (p = 0.971), were found. Total direct cost per attack amounts to € 1224 for home-based strategy with respect to € 1454 for hospital-based strategy, with a savings of € 230. The economic advantage of the home-based strategy almost doubles if the societal perspective was considered due to a further savings of €169 (less missed work/school days and no travel expenses). CONCLUSIONS Our study suggests that home-based therapies represent a feasible strategy for managing C1-INH-HAE and may result in lower costs and increased value for both patients and the healthcare systems. The findings are relevant to the debate on and extend the extant literature to provide a broader view of value co-creation dynamics for home-based therapies in healthcare and their positive effects. The insights are relevant to practitioners and policy makers.
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Affiliation(s)
- Rosanna Spanò
- Department of Economics, Management, Institutions, University of Naples Federico II, Campus Universitario di Monte S. Angelo, Via Cintia 24, 80126 Naples, Italy
| | - Nadia Di Paola
- Department of Economics, Management, Institutions, University of Naples Federico II, Campus Universitario di Monte S. Angelo, Via Cintia 24, 80126 Naples, Italy
| | - Maria Bova
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Alessandro Barbarino
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
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Bender L, Weidmann H, Rose-John S, Renné T, Long AT. Factor XII-Driven Inflammatory Reactions with Implications for Anaphylaxis. Front Immunol 2017; 8:1115. [PMID: 28966616 PMCID: PMC5605561 DOI: 10.3389/fimmu.2017.01115] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/24/2017] [Indexed: 12/14/2022] Open
Abstract
Anaphylaxis is a life-threatening allergic reaction. It is triggered by the release of pro-inflammatory cytokines and mediators from mast cells and basophils in response to immunologic or non-immunologic mechanisms. Mediators that are released upon mast cell activation include the highly sulfated polysaccharide and inorganic polymer heparin and polyphosphate (polyP), respectively. Heparin and polyP supply a negative surface for factor XII (FXII) activation, a serine protease that drives contact system-mediated coagulation and inflammation. Activation of the FXII substrate plasma kallikrein leads to further activation of zymogen FXII and triggers the pro-inflammatory kallikrein-kinin system that results in the release of the mediator bradykinin (BK). The severity of anaphylaxis is correlated with the intensity of contact system activation, the magnitude of mast cell activation, and BK formation. The main inhibitor of the complement system, C1 esterase inhibitor, potently interferes with FXII activity, indicating a meaningful cross-link between complement and kallikrein-kinin systems. Deficiency in a functional C1 esterase inhibitor leads to a severe swelling disorder called hereditary angioedema (HAE). The significance of FXII in these disorders highlights the importance of studying how these processes are integrated and can be therapeutically targeted. In this review, we focus on how FXII integrates with inflammation and the complement system to cause anaphylaxis and HAE as well as highlight current diagnosis and treatments of BK-related diseases.
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Affiliation(s)
- Lysann Bender
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henri Weidmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Renné
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Clinical Chemistry, Department of Molecular Medicine and Surgery, L1:00 Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Andy T. Long
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Hereditary angioedema (HAE) with C1-inhibitor (C1-Inh) deficiency (C1-Inh-HAE) is a rare, life-threatening, and disabling genetic disorder characterized by self-limited tissue swelling caused by deficiency or dysfunction of C1-Inh. Our aim in this update is to discuss new advances in HAE therapy, focusing mainly on the various treatment options that have become available recently and also drugs that are under trial for prophylaxis to prevent attacks. There is a paradigm shift to where the treatment of HAE is headed, focusing now on prophylactic treatment rather than abortive management.
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Affiliation(s)
- Geetika Sabharwal
- Division of Pulmonary, Allergy and Critical Care, Department of Allergy and Immunology, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Timothy Craig
- Division of Pulmonary, Allergy and Critical Care, Department of Allergy and Immunology, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, USA
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Pham H, Santucci S, Yang WH. Successful use of daily intravenous infusion of C1 esterase inhibitor concentrate in the treatment of a hereditary angioedema patient with ascites, hypovolemic shock, sepsis, renal and respiratory failure. Allergy Asthma Clin Immunol 2014; 10:62. [PMID: 25520740 PMCID: PMC4268856 DOI: 10.1186/s13223-014-0062-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/20/2014] [Indexed: 01/09/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease most commonly associated with defects in C1 esterase inhibitor (C1-INH). HAE manifests as recurrent episodes of edema in various body locations. Atypical symptoms, such as ascites, acute respiratory distress syndrome, and hypovolemic shock, have also been reported. Management of HAE conventionally involves the treatment of acute attacks, as well as short- and long-term prophylaxis. Since attacks can be triggered by several factors, including stress and physical trauma, prophylactic therapy is recommended for patients undergoing surgery. Human plasma-derived C1-INH (pdC1-INH) concentrate is indicated for the treatment of both acute HAE attacks and pre-procedure prevention of HAE episodes in patients undergoing medical, dental, or surgical procedures. We report the first case of a patient with HAE who experienced an abdominal attack precipitated by a retroperitoneal bleed while being converted from warfarin to heparin in preparation for surgery. Subsequently, the patient had a protracted course in hospital with other complications, which included hypovolemic shock, ascites, severe sepsis from nosocomial pneumonia, renal and respiratory failure. Despite intensive interventions, the patient remained in a critical state for months; however, after a trial of daily intravenous infusion of pdC1-INH concentrate (Berinert®, CSL Behring GmbH, Marburg, Germany), clinical status improved, particularly renal function. Therefore, pdC1-INH concentrate may be an effective treatment option to consider for critically-ill patients with HAE.
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Affiliation(s)
- Hoang Pham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | | | - William H Yang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Allergy & Asthma Research Centre, Ottawa, Ontario Canada
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Werner R, Keller M, Woehrle JC. Facial Angioedema and Stroke. Cerebrovasc Dis 2014; 38:101-6. [DOI: 10.1159/000365205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/11/2014] [Indexed: 11/19/2022] Open
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Xu YY, Zhi YX, Liu RL, Craig T, Zhang HY. Upper airway edema in 43 patients with hereditary angioedema. Ann Allergy Asthma Immunol 2014; 112:539-544.e1. [PMID: 24698534 DOI: 10.1016/j.anai.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/22/2014] [Accepted: 03/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Upper airway edema (UAE) occurs infrequently in hereditary angioedema (HAE), but still results in significant morbidity and mortality. OBJECTIVE To assess patients with HAE and UAE to determine whether unique features exist that can predict the risk of UAE. METHODS Clinical, laboratory, and genetic data were compared between 43 patients with HAE and 743 UAE attacks and those without UAE and normal controls after ethics committee approval. RESULTS Most patients had their first episode of UAE in the second (25.6%), third (27.9%), and fourth (23.3%) decades of life, and the mean age at onset was 27.3 years. Evolution of UAE from initial to maximum symptoms was 4.6 hours on average, and most cases (69.8%) progressed within 4 hours. Dyspnea was the most frequent manifestation in per-episode (92.2%) and per-patient (97.7%) analyses. Men developed more asphyxiation attacks (19 vs 2) and underwent more tracheotomies (12 vs 2) than did women. UAE was associated with facial edema in half the studied patients. Patients with a positive family history of UAE had a high risk of UAE attacks. CONCLUSION Symptoms limited to the upper airway should be taken seriously. Dyspnea may be the only manifestation of UAE. UAE attacks most commonly start spontaneously and usually progress rapidly, as quickly as 30 minutes, from awareness of symptoms to maximum airway involvement. Patients with a positive UAE family history are predisposed to UAE attacks, and men appear to be more apt to develop asphyxiation than women.
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Affiliation(s)
- Ying-Yang Xu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Xiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Rui-Ling Liu
- Department of Allergy, Tianjin Medical University General Hospital, Tianjin, China
| | - Timothy Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey, Pennsylvania
| | - Hong-Yu Zhang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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