Icatibant self-administration for on-demand treatment of hereditary angioedema attacks

Published online: November 3, 2016

Hereditary angioedema (HAE) is a complement disorder characterized by recurrent, unpredictable episodes of potentially life-threatening angioedema. On-demand treatment with newly approved and emerging therapies can provide relief for HAE attacks. However, administration at a medical facility is recommended or required for many on-demand treatments. Therefore, patients are subject to significant burden, including the inconvenience of travel, prolonged wait times in the emergency department, and delayed treatment. Current HAE guidelines and consensus recommend a home-based treatment plan whenever possible. There is a need to investigate available therapies as options for home-based on-demand treatment.

In an original article in The Journal of Allergy and Clinical Immunology: In Practice, Otani and colleagues conducted a prospective, multicenter study in the United States comparing home self-administration of icatibant with administration at a medical facility (HCP-administration). Patients 18 years or older with documented type I or II HAE were recruited. The first two HAE attacks that occurred after enrollment were treated with icatibant at medical facilities. A healthcare professional taught patients how to self-administer icatibant during treatment for the second HAE attack. All subsequent HAE attacks were treated with self-administered icatibant. Efficacy, safety, and tolerability data were recorded for each treated HAE attack.

Nineteen patients with HAE received icatibant for 79 distinct HAE attacks. Baseline characteristics of the attacks were similar between the 29 attacks treated with HCP-administration and the 50 attacks treated with self-administration. HAE attacks were treated faster with self-administration compared to HCP-administration. Furthermore, attack duration was significantly shorter for HAE attacks treated with self-administration compared to HCP-administration. Interestingly, treating the HAE attacks sooner was positively associated with faster symptom resolution, supporting the current thinking that treating HAE attacks sooner improves outcomes. Importantly, self-administration of icatibant had a comparable safety and tolerability profile compared to HCP-administration.

This prospective, multi-center study supports the use of icatibant as an effective on-demand therapy for home-based treatment plans. The project described was supported by Grant Number 1UL1TR001102-03.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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