Silvia Leone
University of Genoa, Italy
Title: C1- inhibitors (Berinert ®) verus Icatibant in the treatment of hereditary angioedema
Biography
Biography: Silvia Leone
Abstract
Background: Up to 25% of people in the U.S. experience angioedema and/or urticaria in their lifetimes, accounting for over 1 million ED visits each year. There are two key aetiologies of angioedema: histamine-mediated (acquired) and bradikinin-mediated (hereditary). Any potential lack of awareness can lead to treatment errors and poor outcomes for patients presenting with bradikinin-mediated angioedema.
Objectives: To recognize hereditary angioedema which needs a specific treatment; to discuss the pharmacological differences between C1-inhibitors (Berinert ®) and Icatibant for the treatment of hereditary angioedema.
Methods: All cases of hereditary angioedema were registered for a period of 1 year (2015) in the Emergency Dept. of Galliera Hospital (Genoa, Italy), using a Program called ‘PIESSE’. After this period the data were analyzed, and some considerations were made: the ability to make a prompt diagnosis of hereditary angioedema, and, in particular, the differences between the use of C1-inhibitors and Icatibant.
Results: We observed a total of 39 cases of angioedema. 11 of them were bradikin-mediated. We are glad to point out that all the hereditary angioedemas were recognized immediately by the Medical Doctors due to a particular awareness of this kind of disease. 6 cases were treated with Icatibant, and 5 with C1-inhibitors (Berinert ®).
Conclusion: Both drugs are effective in treating hereditary angioedema, but C1-inihibitors must be administered at higher doses (about 20 U/kg) endovenously in recognized hereditary angioedemas only. They have a human origin (this fact affects their safety), they must be stored in a refrigerated box, and their half-life is very long (approximately 87 hours). Icatibant can also be used in cases of suspected hereditary angioedema; it has a synthetic origin (safer), it can be stored anywhere, and its administration uses pre-filled syringes subcutaneously. It has the great advantage that it can be used by patients themselves who know to be affected by hereditary angioedema. Both drugs are able to relieve symptoms quickly. In our experience Icatibant is better than C1-inhibitors, especially in an Emergency Dept., although the use of Icatibant must be related to a complete knowledge of how to distinguish hereditary from acquired angioedema.