Effect of Bradykinin Receptor Antagonism on ACE Inhibitor-associated Angioedema

Vanderbilt University Medical Center

Status and phase: Terminated; Phase 4

Conditions: ACE Inhibitor-associated Angioedema

Treatments: Other: Placebo; Drug: icatibant

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT01574248

000626

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 33 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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33 participants in 2 patient groups, including a placebo group

icatibant

Experimental group

Description:

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

Treatment:

Drug: icatibant

Placebo

Placebo Comparator group

Description:

Subcutaneous at time 0 and 6 hours

Treatment:

Other: Placebo