Abstract
No specific drugs are licensed for the treatment of ACE inhibitor (ACEI)-acquired angioedema (ACEI-AAE). Icatibant, an antagonist of the B2 receptor of bradykinin, is a potential treatment for this condition; however, its use in this setting is poorly documented. We report here clinical outcomes of 13 patients with ACEI-AAE treated with icatibant, in a real-life setting. Thirteen patients on ACEI seen in an Emergency Department (ED) with angioedema involving face, lips or the upper airways were analyzed. Angioedema due to known causes other than ACEI treatment was excluded. Initially, all patients received standard therapy (antihistamine, corticosteroids and epinephrine). Due to the lack of response and a worsening severity of symptoms, all patients received one subcutaneous injection of icatibant (30 mg/mL). Following icatibant treatment, all patients experienced improvement in the symptoms. The median time from onset of clinical symptoms to injection of icatibant was 3 h (IQR 2.5–5.5 h). Symptom relief was reported at 30 min (IQR 27.5–70 min). A complete resolution of symptoms was observed at 5 h (IQR 4–7 h). Ten patients had previously experienced angioedema attacks. The Median time to complete resolution of the previous attacks was higher (54 h; IQR 33–63 h), than after icatibant (p = 0.002) therapy. No patients required tracheal intubation or tracheotomy, and all patients were discharged within 24 h. No adverse events were reported. Before discharge, all patients were instructed to discontinue ACEI, and to take a different antihypertensive agent. This case series supports the efficacy of icatibant in improving symptoms of ACEI-AAE.
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Acknowledgments
Editorial assistance was provided by Luca Giacomelli, PhD with the support of the Associazione Italiana per lo Studio, la Diagnosi e la Terapia dell’Angioedema Ereditario.
Conflict of interests
Maria Bova has received sponsorship for educational purposes, has been paid for providing consultancy services, and has taken part in clinical trials sponsored by Shire, Pharming NV, CSL-Behring and SOBI. Mar Guilarte has received sponsorship for educational purposes and consultancy services, and has taken part in clinical trials sponsored by Shire, Pharming NV, CSL-Behring and Viropharma Inc. Anna Sala-Cunill has received sponsorship for educational purposes, has been paid for providing consultancy services, and has taken part in clinical trials sponsored by Shire, Pharming NV, CSL-Behring and Viropharma Inc. Grazia Maria Luisa Rizzelli has received sponsorship for educational purposes by Shire. Andrea Zanichelli has received speaker fees from CSL Behring, Shire, SOBI and ViroPharma, and consultancy fees from CSL Behring, Shire and ViroPharma. No funding (e.g. in terms of drug provision) was required for this case series.
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Bova, M., Guilarte, M., Sala-Cunill, A. et al. Treatment of ACEI-related angioedema with icatibant: a case series. Intern Emerg Med 10, 345–350 (2015). https://doi.org/10.1007/s11739-015-1205-9
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DOI: https://doi.org/10.1007/s11739-015-1205-9