Long-term prophylaxis in hereditary angio-oedema: A systematic review

Giorgio Costantino, Giovanni Casazza, Ilaria Bossi, Piergiorgio Duca, Marco Cicardi

Research output: Contribution to journalArticle

Abstract

Objective: To systematically review the evidence regarding long-term prophylaxis in the prevention or reduction of attacks in hereditary angio-oedema (HAE). Design: Systematic review and meta-analysis. Data sources: Electronic databases were searched up to April 2011. Two reviewers selected the studies and extracted the study data, patient characteristics and outcomes of interest. Eligibility criteria for selected studies: Controlled trials for HAE prophylaxis. Results: 7 studies were included, for a total of 73 patients and 587 HAE attacks. Due to the paucity of studies, a meta-analysis was not possible. Since two studies did not report the number of HAE attacks, five studies (52 patients) were finally included in the summary analysis. Four classes of drugs with at least one controlled trial have been proposed for HAE prophylaxis. All those drugs, except heparin, were found to be more effective than placebo. In the absence of direct comparisons, the relative efficacies of these drugs were determined by calculating a RR of attacks (drug vs placebo). The results were as follows: danazol (RR=0.023, 95% CI 0.003 to 0.162), methyltestosterone (RR=0.054, 95% CI 0.013 to 0.163), 3-aminocaproic acid (RR=0.095, 95% CI 0.025 to 0.356), tranexamic acid (RR=0.308, 95% CI 0.195 to 0.479) and C1-INH 0.491 (95% CI 0.395 to 0.607). Conclusions: Few trials have evaluated the benefits of HAE prophylaxis, and all drugs but heparin seem to be effective in this setting. Since there are no direct comparisons of HAE drugs, it was not possible to draw definitive conclusions on the most effective one. Thus, to accumulate evidence for HAE prophylaxis, further studies are needed that consider the doseeefficacy relationship and include a head-to-head comparison between drugs, with the active group, rather than placebo, as the control.

Original languageEnglish
Article numbere000524
JournalBMJ Open
Volume2
Issue number4
DOIs
Publication statusPublished - 2012

Fingerprint

Edema
Pharmaceutical Preparations
Placebos
Heparin
Meta-Analysis
Methyltestosterone
Tranexamic Acid
Danazol
Aminocaproic Acid
Information Storage and Retrieval
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Long-term prophylaxis in hereditary angio-oedema : A systematic review. / Costantino, Giorgio; Casazza, Giovanni; Bossi, Ilaria; Duca, Piergiorgio; Cicardi, Marco.

In: BMJ Open, Vol. 2, No. 4, e000524, 2012.

Research output: Contribution to journalArticle

Costantino, Giorgio ; Casazza, Giovanni ; Bossi, Ilaria ; Duca, Piergiorgio ; Cicardi, Marco. / Long-term prophylaxis in hereditary angio-oedema : A systematic review. In: BMJ Open. 2012 ; Vol. 2, No. 4.
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abstract = "Objective: To systematically review the evidence regarding long-term prophylaxis in the prevention or reduction of attacks in hereditary angio-oedema (HAE). Design: Systematic review and meta-analysis. Data sources: Electronic databases were searched up to April 2011. Two reviewers selected the studies and extracted the study data, patient characteristics and outcomes of interest. Eligibility criteria for selected studies: Controlled trials for HAE prophylaxis. Results: 7 studies were included, for a total of 73 patients and 587 HAE attacks. Due to the paucity of studies, a meta-analysis was not possible. Since two studies did not report the number of HAE attacks, five studies (52 patients) were finally included in the summary analysis. Four classes of drugs with at least one controlled trial have been proposed for HAE prophylaxis. All those drugs, except heparin, were found to be more effective than placebo. In the absence of direct comparisons, the relative efficacies of these drugs were determined by calculating a RR of attacks (drug vs placebo). The results were as follows: danazol (RR=0.023, 95{\%} CI 0.003 to 0.162), methyltestosterone (RR=0.054, 95{\%} CI 0.013 to 0.163), 3-aminocaproic acid (RR=0.095, 95{\%} CI 0.025 to 0.356), tranexamic acid (RR=0.308, 95{\%} CI 0.195 to 0.479) and C1-INH 0.491 (95{\%} CI 0.395 to 0.607). Conclusions: Few trials have evaluated the benefits of HAE prophylaxis, and all drugs but heparin seem to be effective in this setting. Since there are no direct comparisons of HAE drugs, it was not possible to draw definitive conclusions on the most effective one. Thus, to accumulate evidence for HAE prophylaxis, further studies are needed that consider the doseeefficacy relationship and include a head-to-head comparison between drugs, with the active group, rather than placebo, as the control.",
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