Effect of Bradykinin Receptor Antagonism on ACE Inhibitor-associated Angioedema

NCT ID: NCT01574248

Last Updated: 2017-02-17

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

33 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-08-31

Study Completion Date

2016-02-29

Brief Summary

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Individuals with heart disease or high blood pressure are often prescribed angiotensin converting enzyme (ACE) inhibitors to treat their disease. However, the use of ACE inhibitors can be associated with angioedema, a rare but life-threatening condition that causes swelling of the face and other body parts. This study will evaluate the effectiveness of the drug HOE-140 at decreasing symptoms of angioedema in people taking ACE inhibitors who develop the condition.

Detailed Description

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People who take ACE inhibitors may develop angioedema, a condition that causes itchy and painful swelling beneath the skin around the eyes, lips, tongue, throat, hands, or feet. In severe cases, the throat may swell, obstructing the airway and leading to breathing difficulty. ACE inhibitors prevent the breakdown of a natural chemical in the body called bradykinin. Increased levels of bradykinin, which can cause swelling, may contribute to the development of angioedema. Blocking bradykinin receptor cells prevents bradykinin from initiating swelling and may lead to a possible decrease in angioedema symptoms. The purpose of this study is to evaluate the effectiveness of HOE-140, a bradykinin receptor blocker, at reducing symptoms in people with ACE inhibitor-associated angioedema.

This study will enroll people admitted to the emergency room or hospital who have a severe case of ACE inhibitor-associated angioedema. Participants will be randomly assigned to receive an injection of either HOE-140 or placebo. Initially, participants will undergo an electrocardiogram to measure the electrical activity of the heart. Then blood pressure measurements, blood collection, a physical exam to determine the extent and duration of swelling, and photographs of the swelling will occur at 2, 4, 8, 16, and 24 hours following the start of treatment. Questionnaires will be completed by study staff and participants to assess changes in angioedema symptoms and the extent of swelling. Participants will remain in the hospital for 24 to 48 hours, depending on the severity of their symptoms. Blood will be collected at a follow-up visit that will occur 7 days after the resolution of angioedema symptoms.

Conditions

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ACE Inhibitor-associated Angioedema

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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icatibant

30 mg icatibant will be administered subcutaneously 0 and 6 hours after randomization

Group Type EXPERIMENTAL

icatibant

Intervention Type DRUG

Subcutaneous at time 0 and 6 hours

Placebo

Subcutaneous at time 0 and 6 hours

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

Subcutaneous at time 0 and 6 hours

Interventions

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icatibant

Subcutaneous at time 0 and 6 hours

Intervention Type DRUG

Placebo

Subcutaneous at time 0 and 6 hours

Intervention Type OTHER

Other Intervention Names

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Firazyr HOE140

Eligibility Criteria

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Inclusion Criteria

* The subject has ongoing angioedema while taking an ACE inhibitor.
* The subject is between 18 and 80 years of age.

Exclusion Criteria

* The subject has had angioedema while not taking an ACE inhibitor.
* The subject's angioedema only involves the bowel.
* The subject is known to be pregnant or has a positive urine pregnancy test.
* The subject has started on an oral contraceptive within the last 6 months.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shire

INDUSTRY

Sponsor Role collaborator

Vanderbilt University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Nancy J. Brown

Chair Department of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nancy J. Brown, MD

Role: PRINCIPAL_INVESTIGATOR

Vanderbilt University

Locations

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University of California, San Diego

San Diego, California, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Countries

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United States

References

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Byrd JB, Adam A, Brown NJ. Angiotensin-converting enzyme inhibitor-associated angioedema. Immunol Allergy Clin North Am. 2006 Nov;26(4):725-37. doi: 10.1016/j.iac.2006.08.001.

Reference Type BACKGROUND
PMID: 17085287 (View on PubMed)

Brown NJ, Ray WA, Snowden M, Griffin MR. Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clin Pharmacol Ther. 1996 Jul;60(1):8-13. doi: 10.1016/S0009-9236(96)90161-7.

Reference Type BACKGROUND
PMID: 8689816 (View on PubMed)

Brown NJ, Byiers S, Carr D, Maldonado M, Warner BA. Dipeptidyl peptidase-IV inhibitor use associated with increased risk of ACE inhibitor-associated angioedema. Hypertension. 2009 Sep;54(3):516-23. doi: 10.1161/HYPERTENSIONAHA.109.134197. Epub 2009 Jul 6.

Reference Type BACKGROUND
PMID: 19581505 (View on PubMed)

Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ. Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med. 1998 Oct 29;339(18):1285-92. doi: 10.1056/NEJM199810293391804.

Reference Type BACKGROUND
PMID: 9791144 (View on PubMed)

Zuraw BL. Clinical practice. Hereditary angioedema. N Engl J Med. 2008 Sep 4;359(10):1027-36. doi: 10.1056/NEJMcp0803977. No abstract available.

Reference Type BACKGROUND
PMID: 18768946 (View on PubMed)

Verresen L, Fink E, Lemke HD, Vanrenterghem Y. Bradykinin is a mediator of anaphylactoid reactions during hemodialysis with AN69 membranes. Kidney Int. 1994 May;45(5):1497-503. doi: 10.1038/ki.1994.195.

Reference Type BACKGROUND
PMID: 8072263 (View on PubMed)

Krieter DH, Grude M, Lemke HD, Fink E, Bonner G, Scholkens BA, Schulz E, Muller GA. Anaphylactoid reactions during hemodialysis in sheep are ACE inhibitor dose-dependent and mediated by bradykinin. Kidney Int. 1998 Apr;53(4):1026-35. doi: 10.1111/j.1523-1755.1998.00837.x.

Reference Type BACKGROUND
PMID: 9551414 (View on PubMed)

Bork K, Frank J, Grundt B, Schlattmann P, Nussberger J, Kreuz W. Treatment of acute edema attacks in hereditary angioedema with a bradykinin receptor-2 antagonist (Icatibant). J Allergy Clin Immunol. 2007 Jun;119(6):1497-503. doi: 10.1016/j.jaci.2007.02.012. Epub 2007 Apr 5.

Reference Type BACKGROUND
PMID: 17418383 (View on PubMed)

Brown NJ, Snowden M, Griffin MR. Recurrent angiotensin-converting enzyme inhibitor--associated angioedema. JAMA. 1997 Jul 16;278(3):232-3. doi: 10.1001/jama.278.3.232.

Reference Type BACKGROUND
PMID: 9218671 (View on PubMed)

Other Identifiers

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000626

Identifier Type: -

Identifier Source: org_study_id

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