Ecallantide for the treatment of acute attacks in hereditary angioedema.

Abstract

BACKGROUND:

Hereditary angioedema is a rare genetic disorder characterized by acute, intermittent, and potentially life-threatening attacks of edema of the skin and mucosa. We evaluated ecallantide, a newly developed recombinant plasma kallikrein inhibitor, for the treatment of acute attacks of angioedema.

METHODS:

In this double-blind, placebo-controlled trial, patients with hereditary angioedema presenting with an acute attack were randomly assigned, in a 1:1 ratio, to receive subcutaneous ecallantide, at a dose of 30 mg, or placebo. Two measures of patient-reported outcomes were used to assess the response: treatment outcome scores, which range from +100 (designated in the protocol as significant improvement in symptoms) to -100 (significant worsening of symptoms), and the change from baseline in the mean symptom complex severity score, which range from +2 (representing a change from mild symptoms at baseline to severe symptoms after) to -3 (representing a change from severe symptoms at baseline to no symptoms after). The primary end point was the treatment outcome score 4 hours after study-drug administration. Secondary end points included the change from baseline in the mean symptom complex severity score at 4 hours and the time to significant improvement.

RESULTS:

A total of 71 of the 72 patients completed the trial. The median treatment outcome score at 4 hours was 50.0 in the ecallantide group and 0.0 in the placebo group (interquartile range [IQR], 0.0 to 100.0 in both groups; P=0.004). The median change in the mean symptom complex severity score at 4 hours was -1.00 (IQR, -1.50 to 0.00) with ecallantide, versus -0.50 (IQR, -1.00 to 0.00) with placebo (P=0.01). The estimated time to significant improvement was 165 minutes with ecallantide versus more than 240 minutes with placebo (P=0.14). There were no deaths, treatment-related serious adverse events, or withdrawals owing to adverse events.

CONCLUSIONS:

Four hours after administration of ecallantide or placebo for acute attacks of angioedema in patients with hereditary angioedema, patient-reported treatment outcome scores and mean symptom complex severity scores were significantly better with ecallantide than with placebo. (Funded by Dyax; ClinicalTrials.gov number, NCT00262080.)

• Authors: Marco Cicardi, Robyn J Levy, Donald L McNeil, H Henry Li, Albert L Sheffer, Marilyn Campion, Patrick T Horn, William E Pullman
• Journal: The New England journal of medicine (N Engl J Med) Vol. 363 Issue 6 Pg. 523-31 (Aug 05 2010) ISSN: 1533-4406 [Electronic] United States
• PMID: 20818887 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Peptides
• ecallantide
• Kallikreins

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Angioedemas, Hereditary (drug therapy)
• Double-Blind Method
• Female
• Humans
• Injections, Subcutaneous
• Intention to Treat Analysis
• Kallikreins (antagonists & inhibitors)
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Peptides (adverse effects, therapeutic use)
• Statistics, Nonparametric
• Young Adult