Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 278-282, September 2010

Therapeutic Efficacy of Icatibant in Angioedema Induced by Angiotensin-Converting Enzyme Inhibitors: A Case Series

  • Murat Bas, MD

      Affiliations

    • Hals-, Nasen- und Ohrenklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
    • Corresponding Author InformationAddress for correspondence: Murat Bas, MD, Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 Munich, Germany; 49-89-4140-2370, fax 49-89-4140-4853
    • ,
  • Jens Greve, MD

      Affiliations

    • Department of Otorhinolaryngology, University of Essen, Essen, Germany
    • ,
  • Klaus Stelter, MD

      Affiliations

    • Department of Otorhinolaryngology, University of Munich, Munich, Germany
    • ,
  • Henning Bier, MD

      Affiliations

    • Hals-, Nasen- und Ohrenklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
    • ,
  • Thomas Stark, MD

      Affiliations

    • Hals-, Nasen- und Ohrenklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
    • ,
  • Thomas K. Hoffmann, MD

      Affiliations

    • Department of Otorhinolaryngology, University of Essen, Essen, Germany
    • ,
  • Georg Kojda, PharmD, PhD

      Affiliations

    • Institute of Pharmacology and Clinical Pharmacology, University of Duesseldorf, Dusseldorf, Germany

Received 27 September 2009; received in revised form 9 November 2009, 11 December 2009, 15 January 2010 and 8 February 2010; accepted 22 March 2010. published online 06 May 2010.

Study objective

The pathophysiology of angiotensin-converting enzyme inhibitor (ACEi)–induced angioedema most likely resembles that of hereditary angioedema, ie, it is mainly mediated by bradykinin-induced activation of vascular bradykinin B2 receptors. We hypothesize that the bradykinin B2 receptor antagonist icatibant might be an effective therapy for ACEi-induced angioedema.

Methods

Eight patients with acute ACEi-induced angioedema were treated with a single subcutaneous injection of icatibant. The outcome was assessed by the time to first improvement of symptoms, complete symptom relief, and drug safety. In addition, we retrospectively assessed the clinical course of 47 consecutive patients of our clinic with ACEi-induced angioedema.

Results

First symptom improvement after icatibant injection occurred at a mean time of 50.6 minutes (standard deviation [SD] 21 minutes) and complete relief of symptoms at 4.4 hours (SD 0.8 hours). No patient received tracheal intubation, other drug treatment, tracheotomy, or a second icatibant injection. There were no adverse effects except erythema occurring at the injection site. In the historical comparison group treated with methylprednisolone and clemastine, the mean time to complete relief of symptoms was 33 hours (SD 19.4 hours). Some of these patients received a tracheotomy (3/47), were intubated (2/47), or received a second dose of methylprednisolone (12/47).

Conclusion

Although sample size limits the external validity of our results, the substantial decrease of time to complete symptom relief suggests that this new treatment is likely effective as a pharmacotherapeutic approach to treat ACEi-induced angioedema.

 

 Please see page 279 for the Editor's Capsule Summary of this article.

 Supervising editor: Richard C. Dart, MD, PhD

 Author contributions: MB, JG, and KS defined the research theme. MB, HB, TKH, and GK designed the methods and study design, analyzed the data, interpreted the results, and wrote the article. TS assisted with associated data collection and their interpretation. All authors have contributed to, seen, and approved the article. MB takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online May 5, 2010.

 Reprints not available from the authors.

PII: S0196-0644(10)00279-9

doi:10.1016/j.annemergmed.2010.03.032

Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 278-282, September 2010