Effect of time to treatment on response to C1 esterase inhibitor concentrate for hereditary angioedema attacks.
Ann Allergy Asthma Immunol
; 111(3): 211-5, 2013 Sep.
Article
em En
| MEDLINE
| ID: mdl-23987198
ABSTRACT
BACKGROUND:
C1 esterase inhibitor (C1-INH) concentrate is well established as effective therapy for hereditary angioedema (HAE). It is thought that treatment of an acute HAE attack with C1-INH as early as possible improves efficacy, but there are limited data from prospective studies supporting this recommendation.OBJECTIVE:
To assess the effect of time to treatment (<6 vs ≥6 hours after start of an attack) with 20 U/kg of C1-INH concentrate on efficacy.METHODS:
A post hoc analysis of time to treatment after start of an attack was performed for 2 studies with C1-INH concentrate International Multicenter Prospective Angioedema C1-INH Trial (IMPACT) 1 (randomized, placebo-controlled) and IMPACT 2 (open-label, uncontrolled extension). Because of differences in study design, the data sets were analyzed separately. IMPACT 1 data were analyzed using Cox regression with hazard ratios (HRs). For IMPACT 2 data, linear regression was applied to evaluate whether earlier treatment leads to faster recovery. Descriptive statistics for treatment response were calculated for both studies.RESULTS:
In IMPACT 1, treatment with C1-INH within less than 6 hours after start of an attack resulted in considerably shorter times to onset of symptom relief (HR, 3.36) and complete resolution (HR, 4.30) vs placebo. The benefit of C1-INH compared with placebo was reduced when administered after 6 or more hours (HRs, 1.18 for times to onset of symptom relief and 1.61 for complete resolution). Analysis of IMPACT 2 data indicated slower complete resolution of symptoms with later start of treatment.CONCLUSION:
Early treatment with C1-INH (<6 hours) provides a better treatment response than late treatment (≥6 hours), supporting the international recommendation to treat HAE attacks as early as possible. TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT00168103 and NCT00292981.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Proteína Inibidora do Complemento C1
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Inativadores do Complemento
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Angioedemas Hereditários
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Guideline
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Observational_studies
Limite:
Adolescent
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Adult
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Aged
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Child
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article