Hereditary angioedema: home treatment with icatibant
Published Online: December 26, 2011
Enabling patients with hereditary angioedema (HAE) to receive acute treatment at home for the recurrent, painful, and potentially fatal attacks that characterize their condition has been recognized by international consensus guidelines as an important management goal, which has the potential to reduce the burden of disease and enhance patients’ quality of life.
In a prospective open-label study reported in The Journal of Allergy and Clinical Immunology (JACI), the first of its kind conducted in adult patients with HAE types I and II, Farkas and colleagues assessed the efficacy and safety of icatibant administered by healthcare professionals for home treatment of angioedema attacks (at the time of the study, icatibant was licensed for administration by healthcare professionals only; it is now licensed for self-administration). Supplied as a 3 mL (30 mg) pre-filled syringe for subcutaneous injection, icatibant, a selective B2 receptor antagonist, acts by blocking the effects of bradykinin, a key mediator of angioedema symptoms.
The researchers treated 9 patients for 16 angioedema attacks (including 3 potentially fatal mild to moderate upper airway attacks in 2 patients). Onset of symptom improvement was observed within 0.25–3.25 hours, and all attacks were completely resolved within 4.00–24.33 hours (4.00–6.75 hours for upper airway attacks). Times between attack onset and icatibant administration had no apparent effect on times to symptom relief or complete resolution, and no decline in efficacy of repeat injections was seen in patients treated for multiple attacks. Consistent with the known local tolerability profile of icatibant, all patients experienced injection site reactions of swelling, burning, itching, warm sensation and pain; these were generally mild and resolved within 4–6 hours.
The authors conclude that their results suggest a role for icatibant home therapy in helping patients with HAE to manage their condition, and support the inclusion of icatibant in future HAE home therapy guidelines.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.