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AMelioration of Angiotensin Converting Enzyme Inhibitor Induced Angioedema Study

This study has been completed.
Information provided by:
Technische Universität München Identifier:
First received: June 29, 2010
Last updated: December 22, 2011
Last verified: December 2011

This is a multicenter study recruiting patients with angioedema induced by ACEI.

Open-label treatment with subcutaneous Icatibant compared to a historic group of 47 patients with ACE inhibitor induced angioedema which the investigators have been previously treated in the investigators centers with current "standard" therapy (250 mg methylprednisolon and 2 mg clemastine).

In cases with fast progression of edema after application the study-drug, a second application with icatibant could be necessary. Rescue medication and intervention.

Condition Intervention Phase
Drug: Icatibant (subcutaneous) and plazebo (intravenous)
Drug: Cortisone + Clemastin (intravenous) and plazebo (subcutaneous)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Multicenter Study, Randomized, Double-blind With 2 Groups as Prove of Concept for the Treatment of ACEI Induced Angioedema With Subcutaneous Icatibant

Resource links provided by NLM:

Further study details as provided by Technische Universität München:

Primary Outcome Measures:
  • Time to complete resolution of angioedema

Arms Assigned Interventions
Experimental: Arm A Drug: Icatibant (subcutaneous) and plazebo (intravenous)
Active Comparator: Arm B Drug: Cortisone + Clemastin (intravenous) and plazebo (subcutaneous)

Detailed Description:

Sudden occurrence of subcutaneous or submucosal non-itchy swelling, so-called angioedema, is a well known side effect of angiotensin-converting enzyme inhibitors (ACEi), which may become life-threatening if the upper airway is involved. To be note, ACEi induced angioedema were always located in the head and neck region.

The pathophysiology of ACE inhibitor (ACEi) induced angioedema most likely resembles that of hereditary angioedema (HAE), i.e. it is mainly mediated by bradykinin induced activation of vascular bradykinin B2 receptors (BKR-2). In contrast to an increased bradykinin generation in HAE, treatment with ACEi decreases the bradykinin degradation in plasma and increases the biological activity of bradykinin.

The current pharmacotherapy of ACEi induced angioedema is not satisfactory. Antihistamines and corticosteroids may be effective in the treatment of urticaria with cutaneous edema and itchy, but are theoretically ineffective and hence superfluous in bradykinin induced angioedema. However, glucocorticoids still belong to the standard treatment of angioedema.

We hypothesized that the BKR-2 antagonist icatibant might be an effective therapy for ACEi-induced angioedema.

Patients with ACEi induced angioedema, located in the upper aero-digestive tract will be randomized and treated either with icatibant and plazebo or cortisone with clemastin and plazebo.


Ages Eligible for Study:   18 Years to 84 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age >= 18 <85 years
  • Patient is currently treated with an ACEI
  • Patient must have acute angioedema attack caused by an ACEI
  • Treatment should be administrated within 10 hrs after onset by an ACEI
  • Patient with angioedema of head and /or neck (face, lips, cheeks, tongue, soft palate/uvula, pharynx and larynx)
  • At least one moderate to severe severe angioedema symptom as assessed by the investigator, requiring a medical intervention
  • Signed written Informed Consent Form

Exclusion Criteria:

  • Diagnosis of angioedema that was not caused by ACEI: e.g. hereditary angioedema (C1-INH deficiency), allergy, anaphylaxis, insect bite, trauma, infection, abscess, tumor, post-radiation or post-operative or processes related to salivary glands and others where it is unlikely that the ACEI is causing the angioedema
  • Participation in a clinical trial of another investigational medicinal product (IMP) within 30 days
  • Patients with acute urticaria
  • Patients with a medical history of any angioedema before taking an ACEI
  • Patients with an acute rash or hives in the face or somewhere else
  • Unstable angina or acute myocardial infarction
  • Acute heart failure
  • Serious concomitant illnesses that the physician considers to be a contraindication for participation in the trial
  • Pregnancy and/or breast-feeding
  • Mental condition rendering the patients, in the opinion of the investigator, unable to understand the nature, scope and possible consequences of the study;
  • Unlikely to comply with the protocol, e.g., uncooperative attitude, inability to return for the follow-up visit, or unlikely to complete the study for any reason.
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Please refer to this study by its identifier: NCT01154361

Klinikum rechts der Isar Hals-Nasen-Ohrenklinik der TUM
Munich, Bavaria, Germany, 81675
Sponsors and Collaborators
Technische Universität München
Principal Investigator: Murat Bas, Dr. Klinikum rechts der Isar, Hals-Nasen-Ohrenklinik, Ismaninger Str. 22 81675 München
  More Information

Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT01154361     History of Changes
Other Study ID Numbers: AMACE
Study First Received: June 29, 2010
Last Updated: December 22, 2011

Keywords provided by Technische Universität München:
ACE inhibitor induced angioedema
Non-itching edema
Non-allergic angioedema
Quincke edema
Drug induced angioedema
Bradykinin B2 receptor antagonist
HOE 140

Additional relevant MeSH terms:
Vascular Diseases
Cardiovascular Diseases
Skin Diseases, Vascular
Skin Diseases
Hypersensitivity, Immediate
Immune System Diseases
Angiotensin-Converting Enzyme Inhibitors
Bradykinin B2 Receptor Antagonists
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Vasodilator Agents
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Bradykinin Receptor Antagonists
Complement Inactivating Agents
Immunosuppressive Agents
Immunologic Factors processed this record on April 28, 2017