Icatibant: a novel approach to the treatment of angioedema related to the use of angiotensin-converting enzyme inhibitors

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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“…These results are overall in line with those of previous anecdotal experiences [2,10,[16][17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 91%

“…The use of icatibant in the therapy of ACEI-AAE has been described in a number of anecdotal experiences [2,10,[16][17][18][19][20][21]. Overall, icatibant appears to reduce time to first symptom improvement, and to complete symptom resolution of angioedema.…”

Section: Introductionmentioning

confidence: 99%

Treatment of ACEI-related angioedema with icatibant: a case series

et al. 2015

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“…Steroid, epinefrin, H1-H2 blokerler sıklıkla ilk müdahalede kullanılan ilaçlardır. Icatibant, tip 2 bradikinin reseptör antogonisti olup son yıllarda ACE inhibitörlerine bağlı ve herediter anjioödemde kullanılmaya başlanmıştır [8].…”

Section: Discussionunclassified

Angioedema Due to use of ACE-Inhibitor

Eyigör¹

2015

Ann Clin Anal Med

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ÖzetAnjiyoödem; herediter ya da non-herediter olabilen, cilt, ciltaltı ve mukozaları içe-ren yüz, dil, dudak, larenks ve gastrointestinal vücut bölgelerinin ani, ciddi, genellikle biçimsiz şekilde, geçici şişmesi olarak tanımlanır. Angiotensin Converting Enzim (ACE) inhibitörü ilaçlar esansiyel hipertansiyon ve kronik kalp rahatsızlıkla-rında yaygın olarak kullanılan, etkili ve güvenli ilaçlardır. ACE inhibitör kullanımı-na bağlı anyioödem oldukça nadir olup, literatürde %0,1-0,7 oranında bildirilmiş-tir. ACE inhibitörlerinin tetiklediği anjiyoödemin patofizyolojisi tam olarak bilinmemekle birlikte, bu durumun artmış bradikinin aktivitesiyle ilişkili olarak vazodilatasyon, vasküler permabilitede artışa ve intertisyel ödeme bağlı olabileceği dü-şünülmektedir. Bu çalışmada 65 yaşında erkek hastada lisinopril kullanımına bağ-lı gelişen anjiyoödem olgusu sunularak ACE inhibitörü ilaçların oldukça nadir görü-lebilen yan etkisi literatür bilgileriyle gözden geçirilmiştir. Anahtar KelimelerAnjiyoödem; ACE inhibitörü; Lisinopril Abstract Angioedema; which may be hereditary or non-hereditary, is defined as a sudden, severe, often in awkward, temporary swelling of skin, subcutaneous and mucous membranes of the face, tongue, lip, larynx, and gastrointestinal areas. Angiotensin Converting Enzyme (ACE) inhibitor drugs are widely used in essential hypertension and congestive heart diseases and effective and safe drugs. Angioedema is quite rare due to the use of ACE inhibitors, the rate changes from 0.1 to 0.7% reported in the literature. The pathophysiology of angioedema induced by ACE inhibitors are not completely understood, this situation has been tought to be associated with an increased activity of bradykinin related vasodilatation, increased vascular permeability and interstitial edema. In this study, a case of 65-year-old male patient presented angioedema induced by lisinopril was presented and a very rare side effect of ACE inhibitor drugs was reviewed with the relevant literature.

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“…This has also already been taken up in current treatment guidelines for hereditary and ACE inhibitor-associated angioedema, but clearly more substantiation with clinical evidence is warranted [23][24][25][26][27] .…”

Section: Does Ace Inhibitor Therapy Lead To Marker Increase?mentioning

confidence: 99%

Potential Biomarkers for the Diagnosis of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema

Baş

Storck

Straßen³

2017

ORL

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Background: Angiotensin-converting enzyme inhibitor-induced angioedema (ACEi-AE) is the most frequent drug-induced angioedema. The aim of this study was to evaluate potential biomarkers for the detection of the risk to develop an ACEi-AE. Methods: Adult patients who started antihypertensive treatment with ramipril were included and followed up for 4-6 weeks. At baseline, 3 days, and 4-6 weeks after onset of therapy, blood samples were obtained. Results: Twenty-four patients could be enrolled. The thromboxane values were very heterogeneous, and none of the group differences observed was statistically significant. The values obtained for 6-keto-prostaglandin F1α (6-keto-PGF_1α) showed a statistically significant increase with 10 mg/day doses under ramipril therapy. Conclusions: In this small patient population, it could be shown that determination of 6-keto-PGF_1α is feasible. It may prove to be a valuable blood marker for assessing the risk of developing ACEi-AE.

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Icatibant: a novel approach to the treatment of angioedema related to the use of angiotensin-converting enzyme inhibitors

Cited by 32 publications

References 8 publications

Treatment of ACEI-related angioedema with icatibant: a case series

Treatment of ACEI-related angioedema with icatibant: a case series

Angioedema Due to use of ACE-Inhibitor

Potential Biomarkers for the Diagnosis of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema

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