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Blinded Safety & Efficacy Placebo Controlled Study of Icatibant for Angiotensin Converting Enzyme Inhibitor Induced Angioedema

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01919801
First Posted: August 9, 2013
Last Update Posted: July 12, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborator:
PPD
Information provided by (Responsible Party):
Shire
  Purpose
This study is being conducted to compare the safety and efficacy of icatibant with placebo in the treatment for Angiotensin-Converting Enzyme Inhibitor (ACE-I)-Induced Angioedema in Adults.

Condition Intervention Phase
Angiotensin Converting Enzyme Inhibitor Induced Angioedema Drug: Icatibant Drug: Placebo Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Phase III, Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Study Evaluating the Safety & Efficacy of Icatibant as a Treatment for Angiotensin-Converting Enzyme Inhibitor (ACE-I)-Induced Angioedema in Adults

Resource links provided by NLM:


Further study details as provided by Shire:

Primary Outcome Measures:
  • Time to Meeting Discharge Criteria (TMDC) [ Time Frame: Day 0 up to Day 5 ]
    TMDC was based on the investigator-assessed angioedema-associated upper airway symptom assessments. It was calculated from the time of study drug administration to the earliest time point at which the symptoms of difficulty breathing and difficulty swallowing were absent and the symptoms of voice change and tongue swelling were mild or absent and all subsequent assessments continued to satisfy these conditions. These symptoms were evaluated by the investigator using a 5-point grading scale (0=absent, 1=mild, 2=moderate, 3=severe, and 4=very severe). TMDC was analysed using Kaplan-Meier estimates.

  • Number of Participants With Treatment-emergent Adverse Events (TEAE) and Treatment-emergent Serious Adverse Events (TESAEs) [ Time Frame: From start of study drug administration (Day 0) up to follow-up (Day 5) ]
    An adverse event (AE) was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. An serious adverse event (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. TEAEs were defined as adverse events/serious adverse events that started or worsened after the study drug treatment.

  • Number of Participants With Treatment Emergent Injection Site Reaction [ Time Frame: Day 0 to Day 5 ]
    Injection site reaction included erythema, swelling, cutaneous pain, burning sensation, itching and warm sensation

  • Number of Participants With Clinically Significant Changes in Laboratory Evaluation, Vital Signs, Electrocardiogram (ECG) and Physical Examination [ Time Frame: Day 0 to Day 5 ]
    During laboratory evaluation, serum chemistry and hematology blood tests, and urinalysis were performed. Vital signs parameters included evaluation of pulse rate and systolic and diastolic blood pressure. Standard 12-lead ECGs were performed and ECG recordings were read locally at the study site by a cardiologist. Physical examination was performed with examination of major body systems per routine clinical practice.


Secondary Outcome Measures:
  • Time to Onset of Symptom Relief (TOSR) [ Time Frame: Day 0 up to Day 5 ]
    TOSR was calculated for the individual symptoms with pre-treatment scores of 2 (moderate) or more improved by at least 1 severity grade and the individual symptoms with pretreatment scores of 0 or 1 (absent or mild) were scored again at 0 or 1 and all the subsequent assessments continued to satisfy this condition. Time-to-event data were summarized using Kaplan-Meier estimates.

  • Number of Participants Experienced Airway Intervention Due to ACE-I-induced Angioedema [ Time Frame: Day 0 up to Day 5 ]
    Airway Intervention included intubation, tracheotomy, cricothyrotomy.

  • Number of Participants Admitted to Hospital or Intensive Care Unit (ICU) [ Time Frame: Day 0 up to Day 5 ]
    Number of participants with and without an occurrence of admission to the hospital (inpatient) or ICU post-treatment due to the ACE-I-induced angioedema attack were described.

  • Number of Participants Experienced ACE-I-induced Angioedema Attack Following Study Drug Administration [ Time Frame: Day 0 up to Day 5 ]
    Number of participants with the use of conventional medications (corticosteroids, antihistamines, epinephrine) for the treatment of symptoms of the ACE-I- induced angioedema attack following study drug administration were presented.

  • Percentage of Participants With Time to Meeting Discharge Criteria (TMDC) at Specified Time Points [ Time Frame: 4, 6, and 8 hours post treatment ]
    TMDC was based on the investigator-assessed angioedema-associated upper airway symptom assessments. It was calculated from the time of study drug administration to the earliest time point at which the symptoms of difficulty breathing and difficulty swallowing were absent and the symptoms of voice change and tongue swelling were mild or absent and all subsequent assessments continued to satisfy these conditions. These symptoms were evaluated by the investigator using a 5-point grading scale (0=absent, 1=mild, 2=moderate, 3=severe, and 4=very severe). TMDC was analysed using Kaplan-Meier estimates.


Other Outcome Measures:
  • Area Under the Plasma Concentration Versus Time Curve (AUC) of Icatibant and Its Metabolites (M1 and M2) [ Time Frame: 0.75 and 2 hours post-dose ]
    Area under the plasma concentration-time curve of Icatibant and its metabolites (M1 and M2) were analyzed. A population pharmacokinetic analysis approach using sparse pharmacokinetic sampling obtained from a subset of subjects was used to evaluate exposure to icatibant.


Enrollment: 118
Study Start Date: December 2013
Study Completion Date: August 2015
Primary Completion Date: August 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Icatibant
Icatibant at a dose of 30 mg will be administered as a single subcutaneous injection
Drug: Icatibant
Single dose of 30 mg icatibant administered within 12 hours of the onset of an acute attack of ACE-I-induced angioedema
Other Name: Firazyr
Placebo Comparator: Placebo
Placebo will be administered as a single subcutaneous injection
Drug: Placebo

Detailed Description:

Angiotensin-converting enzyme inhibitors (ACE-Is) are the class of medications prescribed most frequently for the treatment of hypertension. They are also used post myocardial infarction as well as in patients with heart failure, diabetes mellitus, and chronic kidney disease. Approximately 35 to 40 million patients are on ACE-Is worldwide.

Study HGT-FIR-096 is a multicenter, Phase III, randomized, double-blind, two-armed, placebo-controlled trial. The study population will consist of 118 adult patients, 18 years of age or older, who present with an acute ACE-I-induced angioedema attack. The primary aim of the study is to demonstrate that icatibant is significantly more effective than placebo in resolving attacks of angioedema caused by ACE-I based on the Time to Meeting Discharge Criteria (TMDC). Safety and tolerability, as well as the pharmacokinetics (PK), of icatibant will also be evaluated. Eligible patients will be randomized at a 1:1 ratio to receive a single sub-cutaneous injection of either 30 mg icatibant or placebo.

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female, 18 years of age or older.
  2. Patient is currently being treated with an ACE inhibitor.
  3. Patient presenting with an ACE inhibitor-induced angioedema attack of the head and/or neck region within 12 hours of onset (must be sufficiently less than 12 hours to allow study drug to be given with 12 hours of attack onset).
  4. Angioedema must be considered at least moderate in severity for at least one of the four angioedema-associated airway symptoms (difficulty breathing, difficulty swallowing, voice changes, tongue swelling).
  5. Patient must have voluntarily signed an Institutional Review Board/Independent Ethics Committee-approved informed consent form after all relevant aspects of the study have been explained and discussed with the patient.
  6. Females must have a negative urine pregnancy test prior to administration of the study medication, with the exception of those females who have had a total hysterectomy or bilateral oophorectomy, or who are 2 years post-menopausal.

Exclusion Criteria:

  1. Patient has a diagnosis of angioedema of other etiology (eg, hereditary or acquired angioedema, allergic angioedema [eg, food, insect bite or sting, evident clinical response to antihistamines and/or corticosteroids], anaphylaxis, trauma, abscess or infection or associated disease, local inflammation, local tumor, post-operative or post-radiogenic edema, salivary gland disorders, other [non-ACE inhibitor] drug-induced angioedema).
  2. Patients with a family history of recurrent angioedema.
  3. Patients who have had a previous episode(s) of angioedema while not on ACE inhibitor therapy.
  4. Patients with acute urticaria (itchy, erythematous wheals).
  5. Patients who have an intervention to support the airway (eg, intubation, tracheotomy, cricothyrotomy) due to the current attack of angioedema.
  6. Patient has any of the following vascular conditions that, in the judgment of the investigator, would be a contraindication to participation in the study.

    • Unstable angina pectoris or acute myocardial ischemia
    • Hypertensive urgency or emergency (diastolic blood pressure [DBP] >120 mm Hg or systolic blood pressure [SBP] >180 mm Hg)
    • Within 1 month of a stroke or transient ischemic attack
    • New York Heart Association (NYHA) heart failure class IV
  7. Patient has a serious or acute condition or illness that, in the judgment of the investigator, would interfere with evaluating the safety and/or efficacy assessments of the study (eg, a condition or illness requiring hemodialysis).
  8. Patient is pregnant or breast feeding.
  9. Patient has participated in another investigational study in the past 30 days.
  10. Patient is unable to understand the nature, scope, and possible consequences of the protocol, or is unlikely or unable to comply with the protocol assessments, or is unlikely to complete the study for any reason.
  11. Patients who are not suitable for the study in the opinion of the investigator.
  12. Patient has experienced hypersensitivity to the active substance of the investigational product or to any of its excipients.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01919801


  Show 55 Study Locations
Sponsors and Collaborators
Shire
PPD
Investigators
Study Director: Vipin Aggarwal, MD, MPH Shire
  More Information

Responsible Party: Shire
ClinicalTrials.gov Identifier: NCT01919801     History of Changes
Other Study ID Numbers: HGT-FIR-096
2014-001213-12 ( EudraCT Number )
First Submitted: July 25, 2013
First Posted: August 9, 2013
Results First Submitted: August 16, 2016
Results First Posted: October 10, 2016
Last Update Posted: July 12, 2017
Last Verified: July 2017

Keywords provided by Shire:
ACE-I
Firazyr
icatibant

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