• Am J Emerg Med · Feb 2023

    Randomized Controlled Trial Multicenter Study

    Efficacy of human C1 esterase inhibitor concentrate for treatment of ACE-inhibitor induced angioedema.

    • Ulrich Strassen, Murat Bas, Magdalena Wirth, Markus Wirth, Moritz Gröger, Klaus Stelter, Stefan Volkenstein, Victoria Kehl, Georg Kojda, Thomas K Hoffmann, Janina Hahn, Susanne Trainotti, and Jens Greve.
    • Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Germany. Electronic address: u.strassen@tum.de.
    • Am J Emerg Med. 2023 Feb 1; 64: 121128121-128.

    BackgroundACE inhibitor (ACEi) induced angioedema predominantly affects the upper aerodigestive tract. As ACEi induced angioedema is mediated by bradykinin, therapeutic response to antihistamines and glucocorticoids remains unsatisfactory. In bradykinin mediated hereditary angioedema, C1-esterase inhibitor (C1INH) is an effective and approved treatment since many years. Our aim was to evaluate the therapeutic effect of C1INH in ACEi induced angioedema.MethodsWe performed a double-blind, parallel-group, multicentre randomised placebo-controlled trial between December 2013 and September 2018. Eligible were adults with ACEi induced angioedema with airway obstruction. Participants were randomised 1:1 to single doses of either C1INH (20 IU/kg) or placebo (0.9% NaCl) i.v in addition to standard care (i.v. 500 mg prednisolone and 2.68 mg clemastine) i.v. Composite symptom scores were assessed at baseline and up to 48 h, at discharge and 1 week after discharge. Physician assessed time to complete oedema resolution (TCER) and time to onset of relief (TOR).Results30 patients (16 C1INH, 14 placebo) were randomised and dosed. 25 (9 C1INH, 12 placebo) completed the study. TCER was 29.63 h ± 15.56 h in the C1INH and 17.29 h ± 10.40 h in the placebo arm (p = 0.0457). TORs were 4.13 h ± 3.38 h and 2.86 h ± 1.29 h for C1INH and placebo, respectively (p = 0.4443). There were no adverse events related to study medication.ConclusionsIn the context of baseline application of steroids and antihistamines C1INH was inferior in the treatment of ACEi induced angioedema when compared to placebo with respect to time to complete resolution of symptoms. Eudra-CT Number: 2012-001670-28.Copyright © 2022 Elsevier Inc. All rights reserved.

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