January 28th, 2015

Icatibant Is Effective in Patients with ACE Inhibitor–Induced Angioedema

Icatibant, a selective bradykinin B2-receptor antagonist approved for hereditary angioedema, is associated with 70% faster resolution of ACE inhibitor–induced angioedema than usual care, a phase II trial in the New England Journal of Medicine finds.

Nearly 30 adults presenting within 10 hours of onset of ACE inhibitor–induced angioedema of the upper aerodigestive tract were randomized to subcutaneous injection of icatibant or usual therapy (intravenous prednisolone plus the antihistamine clemastine).

Median time to full resolution of angioedema was shorter in the icatibant than the usual-care group (8 vs. 27 hours); five icatibant patients (38%) had full symptom resolution within 4 hours, compared with no usual-care patients. The only adverse events in the icatibant group were injection-site reactions.

Although this was a small, phase II trial, the results were very impressive. Icatibant is extremely expensive (>US$8000 per 30-mg dose), but if it can prevent an ICU stay or tracheotomy, it will be worth the high cost.

–By David Amrol, MD

Dr. Amrol is a contributing editor with NEJM Journal Watch General Medicine, from which this summary was adapted.

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