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Researchers Test Three Agents for Hereditary Angioedema

C1 inhibitor, ecallentide, and icatibant found effective for management, relief

WEDNESDAY, Aug. 4 (HealthDay News) -- Researchers have found C1 inhibitor concentrate, ecallantide (a recombinant plasma kallikrein inhibitor), and icatibant (a selective bradykinin B2 receptor antagonist) effective in the management and relief of symptoms of hereditary angioedema, according to three studies published in the Aug. 5 issue of the New England Journal of Medicine.

Bruce L. Zuraw, M.D., of the University of California in San Diego, and colleagues evaluated C1 inhibitor concentrate for managing hereditary angioedema in two trials. First, they compared nanofiltered C1 inhibitor concentrate in 35 subjects against placebo in 33 subjects and found that the patients in the treatment group experienced relief in two hours, versus more than four hours in the control group. Second, they performed a crossover trial in 22 patients using twice-weekly prophylactic injections of nanofiltered C1 inhibitor concentrate or placebo and found the number of attacks per test period was 6.26 in the treatment group and 12.73 in the control group.

Marco Cicardi, M.D., from the University of Milan in Italy, and colleagues randomly assigned 72 patients with hereditary angioedema presenting with an acute attack to 30 mg subcutaneous ecallantide or placebo. With patient-reported treatment outcome scores of +100 (significant improvement) to −100 (significant worsening), the ecallentide group reported a score of 50.0 at four hours versus 0.0 in the placebo group. In a third study, Cicardi and colleagues conducted two trials to evaluate icatibant as a treatment for patients presenting with cutaneous or abdominal attacks associated with their hereditary angioedema. They randomized 56 and 74 patients to icatibant or placebo and icatibant or oral tranexamic acid, respectively. They determined that patients receiving icatibant experienced symptom relief more quickly than those receiving placebo or tranexamic acid.

"In patients with hereditary angioedema having acute attacks, we found a significant benefit of icatibant as compared with tranexamic acid in one trial and a nonsignificant benefit of icatibant as compared with placebo in the other trial," write the authors of the third study.

Several authors of the first study disclosed financial ties to pharmaceutical companies, including Lev Pharmaceuticals, which supported the study. The second study was supported by Dyax, which makes ecallentide and employs two co-authors. The third study was supported by Jerini, which makes icatibant and employs several study authors.

Full Text - C1 Inhibitor (subscription or payment may be required)
Full Text - Ecallantide (subscription or payment may be required)
Full Text - Icatibant (subscription or payment may be required)
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