Escalating doses of C1 esterase inhibitor (CINRYZE) for prophylaxis in patients with hereditary angioedema.

Abstract

BACKGROUND:

Nanofiltered C1 inhibitor (human) is approved in the United States for routine prophylaxis of angioedema attacks in patients with hereditary angioedema, a rare disease caused by a deficiency of functional C1 inhibitor.

OBJECTIVE:

To assess the safety of escalating doses of nanofiltered C1 inhibitor (human) in patients who were not adequately controlled on the indicated dose (1000 U every 3 or 4 days).

METHODS:

Eligible patients had >1 attack/month over the 3 months before the trial. Doses were escalated to 1500 U every 3 or 4 days for 12 weeks, at which point, the patients were evaluated. If treatment was successful (≤1 attack/mo) or at the investigator's discretion, the patients entered a 3-month follow-up period. The patients with an average of >1 attack/month were eligible for further escalation to 2000 U and then 2500 U.

RESULTS:

Twenty patients started at 1500 U; 13 were escalated to 2000 U, and 12 were escalated to 2500 U. Eighteen patients reported adverse events. Two patients reported 4 serious adverse events (cerebral cystic hygroma, laryngeal angioedema attack, anemia, and bile duct stone) that were considered by investigators to be unrelated to treatment. Notably, there were no systemic thrombotic events or discontinuations due to adverse events. Fourteen patients were treated successfully (70%), continued to the follow-up period at the investigator's discretion, or experienced a reduction in attacks of >1.0/month.

CONCLUSIONS:

Dose escalation of nanofiltered C1 inhibitor (human) up to 2500 U was well tolerated and reduced attack frequency in the majority of patients.

• Authors: Jonathan A Bernstein, Michael E Manning, Henry Li, Martha V White, James Baker, William R Lumry, Mark A Davis-Lorton, Kraig W Jacobson, Richard G Gower, Colin Broom, David Fitts, Jennifer Schranz
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) 2014 Jan-Feb Vol. 2 Issue 1 Pg. 77-84 ISSN: 2213-2198 [Print] United States
• PMID: 24565773 (Publication Type: Clinical Trial, Phase IV, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Complement C1 Inactivator Proteins
• Complement C1 Inhibitor Protein
• SERPING1 protein, human
• Complement C1s

Topics

• Adolescent
• Adult
• Aged
• Algorithms
• Angioedemas, Hereditary (diagnosis, enzymology, immunology, prevention & control)
• Complement C1 Inactivator Proteins (administration & dosage, adverse effects)
• Complement C1 Inhibitor Protein
• Complement C1s (antagonists & inhibitors, metabolism)
• Drug Administration Schedule
• Drug Dosage Calculations
• Female
• Humans
• Male
• Middle Aged
• Time Factors
• Treatment Outcome
• United States
• Young Adult