Background: ACE inhibitor-induced angioedema is a rare, yet potentially fatal, drug side effect. Considering nearly 40 million people are taking ACE inhibitors for their anti-hypertensive and renal-protective benefits, a significant number of patients are at risk for this drug-induced angioedema. This review was performed to evaluate the efficacy of icatibant as treatment for ACE inhibitor-induced angioedema. Strength of evidence was evaluated using the GRADE tool.
Method: An exhaustive search of available medical literature was conducted using Medline, PubMed, ISI Web of Science, EBM Reviews Multifile, and CINAHL. Inclusion and exclusion criteria were applied. At the time of this review, no randomized control trials were published; therefore, this review focuses on case reports.
Results: During the exhaustive literature search, only two case reports were found regarding the use of icatibant as treatment for ACE inhibitor-induced angioedema. Both studies included in the review showed substantial reduction in time to complete resolution of symptoms from ACE inhibitor angioedema using icatibant as compared to standard therapy. Only local-site reactions of erythema and pruritus were evident as side-effects from icatibant therapy.
Conclusion: Despite the small sample size of the studies, the overall Moderate GRADE outcome, and the limited statistical significance from these observational reports, icatibant appears to dramatically reduce time to: 1) first symptom improvement, and 2) complete symptom resolution of angioedema, as compared to standard therapy. Therefore, the clinical significance of icatibant as a treatment modality for ACE inhibitor angioedema is noteworthy, and should be further investigated by randomized control trials.
Keywords: angiotensin converting enzyme, ACE inhibitor, angioedema, icatibant, and Firazyr
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