Drugs used in hereditary angioedema

Icatibant Acetate

Approved 15 Jul 2019SubcutaneousInjectable

The FDA lists this product in 10 strengths and forms.

Indications

Icatibant Injection is indicated for the treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older. Icatibant Injection is a bradykinin B2 receptor antagonist indicated for treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older. ( 1 )

Contraindications

None. None ( 4 )

Warnings and precautions

Laryngeal attacks: Following treatment of laryngeal attacks with icatibant, advise patients to seek immediate medical attention. ( 5.1 )

5.1Laryngeal Attacks Given

the potential for airway obstruction during acute laryngeal HAE attacks, patients should be advised to seek medical attention in an appropriate healthcare facility immediately in addition to treatment with icatibant.

Interactions

7.1ACE Inhibitors

Icatibant is a bradykinin B2 receptor antagonist and thereby has the potential to have a pharmacodynamic interaction with ACE inhibitors where icatibant may attenuate the antihypertensive effect of ACE inhibitors. Clinical trials to date have excluded subjects taking ACE inhibitors.

Pregnancy and breastfeeding

8.1Pregnancy Risk Summary

Available data from published literature and the pharmacovigilance database with icatibant use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. In animal reproduction studies, icatibant, administered by the subcutaneous route during the period of organogenesis, did not cause structural abnormalities in rats or rabbits; however, premature birth and abortion were observed in rabbits at doses approximately 0.025 times the maximum recommended human dose (MRHD) and higher.

Indications

Warnings and precautions

Laryngeal attacks: Following treatment of laryngeal attacks with icatibant, advise patients to seek immediate medical attention. ( 5.1 )

5.1Laryngeal Attacks Given

Interactions

7.1ACE Inhibitors

Pregnancy and breastfeeding

8.1Pregnancy Risk Summary

Adverse reactions

The most commonly reported adverse reactions were injection site reactions, which occurred in almost all patients (97%) in clinical trials. Other common adverse reactions occurring in greater than 1% of patients included pyrexia, transaminase increase, dizziness, and rash. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Teva at 1-888-838-2872 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

6.1Clinical Trials Experience

The safety of icatibant was evaluated in three controlled trials that included 223 patients who received icatibant 30 mg (n=113), placebo (n=75), or comparator (n=38). The mean age at study entry was 38 years (range 18 to 83 years), 64% were female, and 95% were white. The data described below represent adverse reactions observed from the two placebo-controlled trials, consisting of 77 patients who received icatibant at a dose of 30 mg SC, and 75 who received placebo.

The most frequently reported adverse reactions (occurring in greater than 1% of patients and at a higher rate with icatibant versus placebo) are shown in Table 1. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Table 1: Adverse Reactions Observed in >1% of Patients with Acute Attacks of HAE and at a Higher Rate with Icatibant versus Placebo in the Placebo-controlled Trials a Icatibant (N=77) Placebo (N=75) System Organ Class Preferred Term Subjects (%) Subjects (%) General disorders and administration site conditions Injection site reaction b 75 (97) 25 (33) Pyrexia 3 (4) 0 Investigations Transaminase increased 3 (4) 0 Nervous system disorders Dizziness 2 (3) 1 (1) a Events occurring within 14 days of study drug administration b Injection site bruising, Injection site hematoma, Injection site burning, Injection site erythema, Injection site hypoesthesia, Injection site irritation, Injection site numbness, Injection site edema, Injection site pain, Injection site pressure sensation, Injection site pruritus, Injection site swelling, Injection site urticaria, and Injection site warmth The third trial was active-controlled and was comprised of 35 patients who received icatibant 30 mg and 38 patients who received the comparator.

Adverse reactions for icatibant were similar in nature and frequency to those reported in Table 1. In all three controlled trials, patients were eligible for treatment of subsequent attacks in an open-label extension. Patients were treated with Icatibant Injection 30 mg and could receive up to 3 doses of Icatibant Injection 30 mg administered at least 6 hours apart for each attack. A total of 225 patients were treated with 1,076 doses of 30 mg Icatibant Injection for 987 attacks of acute HAE.

Adverse reactions similar in nature and frequency were observed to those seen in the controlled phase of the trials. Other adverse reactions reported included rash, nausea, and headache in patients exposed to Icatibant Injection. The safety of self-administration was evaluated in a separate, open-label trial in 56 patients with HAE. In this trial, the safety profile of Icatibant Injection in patients who self-administered Icatibant Injection was similar in nature and frequency to that of patients whose therapy was administered by healthcare professionals.

6.2Immunogenicity

Across repeated treatment in the controlled trials, 4 patients tested positive for anti-icatibant antibodies. Three of these patients had subsequent tests which were negative. No hypersensitivity or anaphylactic reactions were reported with icatibant. No association between anti-icatibant antibodies and efficacy was observed.

6.3Postmarketing Experience

The following adverse reactions have been identified during post approval use of icatibant: urticaria. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Icatibant Acetate

Indications

Contraindications

Warnings and precautions

5.1Laryngeal Attacks Given

Interactions

7.1ACE Inhibitors

Pregnancy and breastfeeding

8.1Pregnancy Risk Summary

Two medicines in one question?

Icatibant Acetate

Indications

Contraindications

Warnings and precautions

5.1Laryngeal Attacks Given

Interactions

7.1ACE Inhibitors

Pregnancy and breastfeeding

8.1Pregnancy Risk Summary

Two medicines in one question?

Adverse reactions

6.1Clinical Trials Experience

6.2Immunogenicity

6.3Postmarketing Experience

Composition

Strengths and forms

Official product information

At a glance