SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 21, 2007

Ecallantide therapy of hereditary angioedema

Summary

Background - There is a need for effective and safe treatment agents in acute episodes of hereditary angioedema (HAE). It is generally agreed that increased formation of bradykinin (BK) via the kallikrein (KK) - kinin activation cascade plays a major role in acute angioedema episodes in HAE.

Findings - Schneider et al of the Children's Hospital in Boston, MA investigated the therapeutic effects of varying doses of ecallantide (Ecal), an inhibitor of KK, in a double-blind, placebo-controlled trial of the treatment of acute angioedema attacks in HAE.

They found that the acute HAE attacks were controlled significantly within 4 hours in 72% of the Ecal treated and in 25% of the placebo treated patients.

Reference
J Allergy Clin Immunol 2007;120:416-22

Editor's Comments
The promising findings in this pilot study of Ecal effects strongly support the role of KK activation and subsequent generation of BK in the pathogenesis of acute HAE attacks. Ecal is a recombinant protein which is a potent and specific inhibitor of KK. This treatment does not correct the primary deficit in HAE (decreased or dysfunctional C1 INH levels). In European studies, a concentrated C1 INH preparation has been found to be a safe and effective treatment of acute HAE attacks. However, this preparation has not yet been approved by the FDA.

 

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