Effect of bradykinin receptor antagonism on ACE inhibitor-associated angioedema

Publication date: Available online 29 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Brittany T. Straka, Claudia E. Ramirez, James B. Byrd, Elizabeth Stone, Alencia Woodard-Grice, Hui Nian, Chang Yu, Aleena Banerji, Nancy J. Brown
BackgroundThe B2 receptor antagonist icatibant is approved for treatment of attacks of hereditary angioedema. Icatibant has been reported to decrease time-to-resolution of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema in one study of European patients.MethodsPatients with ACE inhibitor-associated angioedema (defined as swelling of lips, tongue, pharynx or face during ACE inhibitor use and no swelling in the absence of ACE inhibitor use) were enrolled at Vanderbilt University Medical Center from October 2007 through September 2015 and at Massachusetts General Hospital in 2012. C1 inhibitor deficiency and patients with bowel edema only were excluded. Patients were randomized within six hours of presentation to subcutaneous icatibant 30 mg or placebo at zero and six hours later. Patients assessed severity of swelling using a visual analog scale serially following study drug administration or until discharge.ResultsThirty-three patients were randomized and 31 received treatment, with 13 receiving icatibant and 18 receiving placebo. One patient randomized to icatibant did not complete the visual analog scale and was excluded from analyses. Two-thirds of patients were African American and two-thirds were women. Time-to-resolution of symptoms was similar in placebo and icatibant treatment groups (p=0.19 for the primary symptom and p>0.16 for individual symptoms of face, lip, tongue, or eyelid swelling). Frequency of administration of H1 and H2 blockers, corticosteroids, and epinephrine was similar in the two treatment groups. Time-to-resolution of symptoms was similar in black and white patients.ConclusionsThis study does not support clinical efficacy of a bradykinin B2 receptor antagonist in ACE inhibitor-associated angioedema.

Teaser

This randomized, placebo-controlled double-blind study does not shown any benefit of administration of the bradykinin B2 receptor antagonist icatibant in patients presenting with angiotensin-converting enzyme inhibitor-associated angioedema. This contrasts studies in hereditary angioedema.


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