Advances in Hereditary Angioedema: The Prevention of Angioedema Attacks With Subcutaneous C1-Inhibitor Replacement Therapy.
William Lumry, Teri Templeton, Laurel Omert and 1 others
PMID 32287168WHAT IT FOUND
Subcutaneous C1-inhibitor prophylaxis lowered hereditary angioedema attacks from 4.03 to 0.52 per month versus placebo, with fewer rescue treatments and mostly mild injection-site reactions.
Nurses can train self-administration.
Key findings
01During C1-INH(SC) 60 IU/kg, mean HAE attacks per month were 0.52 compared with 4.03 on placebo (P < .001).
02Rescue medication use was 0.32 uses per month during C1-INH(SC) 60 IU/kg compared with 3.89 uses per month during placebo, and severe attacks made up 9% of attacks compared with 69% during placebo.
03Most adverse events were injection-site reactions, reported by 31% of subjects during C1-INH treatment and 24% during placebo; most were mild and none were severe.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The article is a clinical review, not a new randomized trial. It summarizes other studies instead of testing C1-INH(SC) directly. COMPACT enrolled patients who had frequent HAE attacks that required acute treatment or medical attention, so it may not speak to patients with milder disease. During COMPACT, patients could use on-demand treatments for attacks at any time, including during placebo, so attack rates reflect prophylaxis plus rescue treatment. The long-term extension was open-label, so patients and investigators knew they were receiving C1-INH(SC). Some patient-reported outcome analyses were post hoc, not the primary trial outcome.
The easy way to misread this
Do not read this as evidence that C1-INH(SC) treats an acute angioedema attack. The COMPACT study tested it as routine prophylaxis, and patients could still use on-demand treatments. Nurses should still ensure access to at least 2 doses of attack treatment.