Effect of C1-Esterase-inhibitor in angiotensin-converting enzyme inhibitor-induced angioedema.

Abstract

OBJECTIVES/HYPOTHESIS:

The study objective was to generate pilot data to evaluate the effectiveness and safety of C1-esterase-inhibitor concentrate (C1-INH) compared to standard treatment in patients with angiotensin-converting enzyme inhibitor (ACEi)-induced angioedema affecting the upper aerodigestive tract.

STUDY DESIGN:

Proof-of-concept case series with historical control.

METHODS:

Adult patients with angioedema in the upper aerodigestive tract presenting to the emergency department were included. After establishing the diagnosis of ACEi-induced angioedema based on patient history and thorough clinical examination, all patients were administered 1,000 international units (IU) of C1-INH intravenously. A historical control group consisting of adult patients with ACEi-induced angioedema who had been treated with intravenous corticosteroids and antihistamines at the same institution over the past 8 years was used for comparison. The most important parameters assessed were the time to complete resolution of symptoms and the need for intubation or tracheotomy.

RESULTS:

Ten patients were included in the C1-INH group and 47 in the corticosteroid/antihistamine group. The time to complete resolution of symptoms was considerably longer in the historical control group (33.1 ± 19.4 hours) than in the C1-INH group (10.1 ± 3.0 hours). No intubation or tracheotomy was needed in the C1-INH group (0/10 patients), whereas three out of the 47 historical controls required tracheotomy and two were intubated (5/47).

CONCLUSION:

The results suggest a role for C1-INH as an effective and safe therapeutic option in patients with ACEi-induced angioedema, which needs to be confirmed by further larger and double-blinded studies.

LEVEL OF EVIDENCE:

4.

• Authors: Jens Greve, Murat Bas, Thomas K Hoffmann, Patrick J Schuler, Patrick Weller, Georg Kojda, Ulrich Strassen
• Journal: The Laryngoscope (Laryngoscope) Vol. 125 Issue 6 Pg. E198-202 (Jun 2015) ISSN: 1531-4995 [Electronic] United States
• PMID: 25583256 (Publication Type: Controlled Clinical Trial, Journal Article)
• Copyright: © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Complement C1 Inhibitor Protein

Topics

• Angioedema (chemically induced)
• Angiotensin-Converting Enzyme Inhibitors (adverse effects)
• Complement C1 Inhibitor Protein (therapeutic use)
• Female
• Gastrointestinal Diseases (chemically induced, drug therapy)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Respiratory Tract Diseases (chemically induced, drug therapy)