From the Guidelines
Angioedema treatment should prioritize the use of C1-INH, icatibant, or ecallantide for acute attacks, as these medications have been shown to be effective in reducing the duration and severity of attacks 1.
Treatment Overview
The treatment of angioedema depends on the severity and cause of the condition. For hereditary angioedema, specific treatments include:
- C1 esterase inhibitor concentrates (Berinert, Cinryze)
- Icatibant (30mg subcutaneously)
- Ecallantide (30mg subcutaneously) These medications have been shown to be effective in reducing the duration and severity of attacks 1.
Key Considerations
- Epinephrine, corticosteroids, and antihistamines are not recommended for the treatment of hereditary angioedema, as they do not have a significant effect on the swelling seen in patients with this condition 1.
- Long-term prophylaxis for recurrent angioedema may involve medications like danazol, tranexamic acid, or regular C1 inhibitor infusions.
- Identifying and avoiding triggers is crucial for prevention.
- ACE inhibitor-induced angioedema requires immediate discontinuation of the medication and switching to an alternative antihypertensive class.
Treatment Effectiveness
Treatment effectiveness varies based on the underlying cause, with histamine-mediated angioedema responding well to antihistamines and steroids, while bradykinin-mediated forms (like hereditary angioedema) require targeted therapies that address the specific pathway involved 1. Some key points to consider when treating angioedema include:
- The need for early treatment to minimize the duration and severity of attacks
- The importance of identifying and avoiding triggers
- The use of targeted therapies for bradykinin-mediated forms of angioedema
- The need for individualized treatment plans based on the patient's specific needs and circumstances.
From the FDA Drug Label
BERINERT is a plasma-derived C1 Esterase Inhibitor (Human) indicated for the treatment of acute abdominal, facial, or laryngeal hereditary angioedema (HAE) attacks in adult and pediatric patients. The recommended treatment for angioedema is C1 esterase inhibitor (IV), specifically BERINERT, which is indicated for the treatment of acute abdominal, facial, or laryngeal hereditary angioedema (HAE) attacks in adult and pediatric patients 2.
- The safety and efficacy of BERINERT in the treatment of acute abdominal or facial HAE attacks in subjects with hereditary angioedema were demonstrated in a placebo-controlled, double-blind, prospective, multinational, randomized, parallel-group, dose-finding, three-arm, clinical study 2.
- BERINERT was well tolerated and no signs of toxicity were observed up to the highest dose administered in animal studies 2. Key points:
- BERINERT is indicated for the treatment of acute abdominal, facial, or laryngeal HAE attacks.
- BERINERT has demonstrated safety and efficacy in the treatment of acute abdominal or facial HAE attacks.
- BERINERT was well tolerated in animal studies.
From the Research
Angioedema Treatment Options
- Angioedema is a potentially life-threatening condition that requires systematic assessment and treatment 3
- The treatment of angioedema depends on the subtype, which can be either histaminergic or non-histaminergic 3
- Conventional therapy for angioedema includes antihistamines, steroids, and epinephrine, but this may be ineffective in cases of bradykinin-mediated angioedema, such as ACEI-associated angioedema (AAE) 4
Medications for Angioedema Treatment
- C1-esterase inhibitor (C1-INH) has been shown to be effective in treating AAE and can prevent airway compromise and the need for intervention 4
- Icatibant, ecallantide, and fresh frozen plasma are also potential treatment options for AAE, although they are not FDA-approved for this indication 5
- These medications are typically used off-label for the treatment of AAE, but have been shown to be effective in reducing symptoms and preventing serious complications 5
Treatment of Hereditary Angioedema
- Hereditary angioedema (HAE) is a condition characterized by recurrent, unpredictable episodes of bradykinin-mediated edema 6
- Treatment options for HAE include C1-INH, icatibant, and ecallantide, which can be used for acute attacks or as prophylaxis 6
- Fresh frozen plasma is also a potential treatment option for HAE, particularly in low- and middle-income countries where other treatments may not be available 7
Efficacy and Safety of Treatment Options
- C1-INH has been shown to be effective in treating AAE and HAE, with rapid resolution of symptoms and prevention of serious complications 4, 6
- Icatibant and ecallantide have also been shown to be effective in treating AAE, although the evidence is largely based on case reports and small studies 5
- Fresh frozen plasma has been shown to be effective in treating HAE, although it may have a slower time-to-resolution and higher risk of adverse events compared to other treatments 7