In patients with acute hereditary angioedema is Icatibant better than C1 esterase inhibitor at reducing mortality?
Date First Published:
July 12, 2010
Last Updated:
July 13, 2010
Report by:
Katherine Palmer, Medical Student (Manchester Royal Infirmary)
Search checked by:
Katherine Palmer, Manchester Royal Infirmary
Three-Part Question:
In [patients with acute hereditary angioedema] is [Icatibant] better than [C1 esterase inhibitor] at [reducing mortality]?
Clinical Scenario:
A 45 year old female with known hereditary angioedema has a moderately serve acute attack which began 8 hours ago. Her sister died during an acute episode 1 year ago and she is very frightened herself. She has has C1 inhibitor in the past but has read about Icatibant on the internet.
Search Strategy:
MEDLINE 1950 to 2010 June Week 5 and Embase 1980 to 2010 Week 27 using the OVID interface on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
Search Details:
MEDLINE and Embase - (exp Hereditary Angioedema Type III/ OR exp Angioedema/ OR exp "Hereditary Angioedema Types I and II"/ OR hereditary angioedema.mp. OR angioedema.mp.) AND
(exp Complement Inactivator Proteins/ OR exp Complement C1 Inactivator Proteins/ OR exp Complement C1 Inhibitor Protein/ OR c1 esterase inhibitor.mp. OR c1 inhibitor.mp.)AND (exp Receptor, Bradykinin B2/ OR Icatibant.mp. OR firazyr.mp. OR bradykinin 2 receptor antagonist.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Icatibant)
(exp Complement Inactivator Proteins/ OR exp Complement C1 Inactivator Proteins/ OR exp Complement C1 Inhibitor Protein/ OR c1 esterase inhibitor.mp. OR c1 inhibitor.mp.)AND (exp Receptor, Bradykinin B2/ OR Icatibant.mp. OR firazyr.mp. OR bradykinin 2 receptor antagonist.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Icatibant)
Outcome:
MEDLINE - 18 papers, 0 relevant
Embase - 75 papers, 0 relevant
CINAHL - 7 papers, 0 relevant
Embase - 75 papers, 0 relevant
CINAHL - 7 papers, 0 relevant
Author Commentary:
Icatibant is a new treatment for hereditary angioedema and is undergoing clinical trials for both acute and prophylactic therapy. There are currently no trials comparing Icatibant with the current licensed treatment of C1 inhibitor.
Bottom Line:
Until further trials have been conducted treatment of acute hereditary angioedema should be with the licensed C1 inhibitor.