Oral Plasma Kallikrein Inhibitor for Prophylaxis in Hereditary Angioedema.

Aygören-Pürsün, Emel and Bygum, Anette and Grivcheva-Panovska, Vesna and Magerl, Markus and Graff, Jochen and Steiner, Urs C and Fain, Olivier and Huissoon, Aarnoud P and Kinaciyan, Tamar and Farkas, Henriette and Lleonart, Ramon and Longhurst, Hilary J and Rae, William and Triggiani, Massimo and Aberer, Werner and Cancian, Mauro and Zanichelli, Andrea and Smith, William B and Baeza, Maria L and Du-Thanh, Aurelie and Gompels, Mark and Gonzalez-Quevedo, Teresa and Greve, Jens and Guilarte, Mar and Katelaris, Constance and Dobo, Sylvia and Cornpropst, Melanie and Clemons, Desiree and Fang, Lei and Collis, Phil and Sheridan, William and Maurer, Marcus and Cicardi, Marco (2018) Oral Plasma Kallikrein Inhibitor for Prophylaxis in Hereditary Angioedema. The New England journal of medicine, 379 (4). pp. 352-362. ISSN 1533-4406. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://www.nejm.org/doi/full/10.1056/NEJMoa171699...

Abstract

BACKGROUND

Hereditary angioedema is a life-threatening illness caused by mutations in the gene encoding C1 inhibitor (also called C1 esterase inhibitor) that lead to overactivation of the kallikrein-bradykinin cascade. BCX7353 is a potent oral small-molecule inhibitor of plasma kallikrein with a pharmacokinetic and pharmacodynamic profile that may help prevent angioedema attacks.

METHODS

In this international, three-part, dose-ranging, placebo-controlled trial, we evaluated four doses of BCX7353 (62.5 mg, 125 mg, 250 mg, and 350 mg once daily) for the prevention of angioedema attacks over a 28-day period. Patients with type I or II hereditary angioedema with a history of at least two angioedema attacks per month were randomly assigned to BCX7353 or placebo. The primary efficacy end point was the number of confirmed angioedema attacks. Key secondary end points included angioedema attacks according to anatomical location and quality of life.

RESULTS

A total of 77 patients underwent randomization, 75 received BCX7353 or placebo, and 72 completed the trial. The rate of confirmed angioedema attacks was significantly lower among patients who received BCX7353 at daily doses of 125 mg or more than among those who received placebo, with a 73.8% difference at 125 mg (P<0.001). Significant benefits with respect to quality-of-life scores were observed in the 125-mg and 250-mg dose groups (P<0.05). Gastrointestinal adverse events, predominantly of grade 1, were the most commonly reported adverse events, particularly in the two highest BCX7353 dose groups.

CONCLUSIONS

Once-daily oral administration of BCX7353 at a dose of 125 mg or more resulted in a significantly lower rate of attacks of hereditary angioedema than placebo. Mild gastrointestinal symptoms were the principal side effect. (Funded by BioCryst Pharmaceuticals; APeX-1 ClinicalTrials.gov number, NCT02870972 .).

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: QW Microbiology. Immunology
QZ Pathology. Oncology
Divisions: Clinical Support > Pathology
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Depositing User: Mrs Caroline Tranter
Date Deposited: 17 Aug 2018 13:23
Last Modified: 17 Aug 2018 13:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1726

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