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Type: Journal article
Title: Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema
Author: Cicardi, M.
Smith, W.
Citation: New England Journal of Medicine, 2010; 363(6):532-541
Publisher: Massachusetts Medical Soc
Issue Date: 2010
ISSN: 0028-4793
Statement of
M. Cicardi ... W.B. Smith ... et al.
Abstract: BACKGROUND Hereditary angioedema is characterized by recurrent attacks of angioedema of the skin, larynx, and gastrointestinal tract. Bradykinin is the key mediator of symptoms. Icatibant is a selective bradykinin B2 receptor antagonist. METHODS In two double-blind, randomized, multicenter trials, we evaluated the effect of icatibant in patients with hereditary angioedema presenting with cutaneous or abdominal attacks. In the For Angioedema Subcutaneous Treatment (FAST) 1 trial, patients received either icatibant or placebo; in FAST-2, patients received either icatibant or oral tranexamic acid, at a dose of 3 g daily for 2 days. Icatibant was given once, subcutaneously, at a dose of 30 mg. The primary end point was the median time to clinically significant relief of symptoms. RESULTS A total of 56 and 74 patients underwent randomization in the FAST-1 and FAST-2 trials, respectively. The primary end point was reached in 2.5 hours with icatibant versus 4.6 hours with placebo in the FAST-1 trial (P = 0.14) and in 2.0 hours with icatibant versus 12.0 hours with tranexamic acid in the FAST-2 trial (P<0.001). In the FAST-1 study, 3 recipients of icatibant and 13 recipients of placebo needed treatment with rescue medication. The median time to first improvement of symptoms, as assessed by patients and by investigators, was significantly shorter with icatibant in both trials. No icatibant-related serious adverse events were reported. CONCLUSIONS In patients with hereditary angioedema having acute attacks, we found a significant benefit of icatibant as compared with tranexamic acid in one trial and a nonsignificant benefit of icatibant as compared with placebo in the other trial with regard to the primary end point. The early use of rescue medication may have obscured the benefit of icatibant in the placebo trial. (Funded by Jerini; ClinicalTrials .gov numbers, NCT00097695 and NCT00500656.)
Keywords: Humans; Acute Disease; Tranexamic Acid; Bradykinin; Injections, Subcutaneous; Statistics, Nonparametric; Double-Blind Method; Adult; Female; Male; Angioedemas, Hereditary; Intention to Treat Analysis; Bradykinin B2 Receptor Antagonists
Rights: Copyright © 2010 Massachusetts Medical Society. All rights reserved.
RMID: 0020101940
DOI: 10.1056/NEJMoa0906393
Appears in Collections:Medicine publications

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