Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema
Abstract Background Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable localized episodes of edema, which is frequently managed with long-term prophylactic medications. Until recently, long-term prophylaxis has predominantly required regular intravenous or subcutan...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Allergy, Asthma & Clinical Immunology |
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| Online Access: | https://doi.org/10.1186/s13223-021-00603-9 |
| _version_ | 1819118013576642560 |
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| author | Richard G. Gower Mary Wilber |
| author_facet | Richard G. Gower Mary Wilber |
| author_sort | Richard G. Gower |
| collection | DOAJ |
| description | Abstract Background Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable localized episodes of edema, which is frequently managed with long-term prophylactic medications. Until recently, long-term prophylaxis has predominantly required regular intravenous or subcutaneous administration, however the recent approval of berotralstat (Orladeyo™) offers an orally administered prophylactic which may be associated with a lower burden of treatment compared to injectable options for some patients. Case presentation This report describes four participants in the APeX-S trial who transitioned from subcutaneously administered lanadelumab (Takhzyro®) to daily oral berotralstat for long-term HAE prophylaxis. Lanadelumab dosing continued after berotralstat commencement in all patients and was tapered before discontinuation in three of the four patients. No substantial increases in HAE attack rates were observed after the transition to berotralstat monotherapy. One patient experienced a treatment-related adverse event (dyspepsia), which was mild and self-resolving. Conclusions All four patients described in this case series successfully transitioned from lanadelumab to berotralstat monotherapy for long-term prophylaxis without significant complications and without the use of a complex transition protocol. The decision to transition to berotralstat monotherapy and how the transition should be achieved was discussed between patient and physician, ensuring that the comfort and perspectives of the patients were considered during the treatment transition. This report highlights the importance of individualization of HAE management plans to address both the disease and treatment burdens of HAE, and thus to provide the best possible quality of life for each patient. |
| first_indexed | 2024-12-22T05:42:08Z |
| format | Article |
| id | doaj.art-a7e7852ab43c4e329f34d344e14c977e |
| institution | Directory Open Access Journal |
| issn | 1710-1492 |
| language | English |
| last_indexed | 2024-12-22T05:42:08Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Allergy, Asthma & Clinical Immunology |
| spelling | doaj.art-a7e7852ab43c4e329f34d344e14c977e2022-12-21T18:37:10ZengBMCAllergy, Asthma & Clinical Immunology1710-14922021-10-011711710.1186/s13223-021-00603-9Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedemaRichard G. Gower0Mary Wilber1Marycliff Clinical ResearchMarycliff Clinical ResearchAbstract Background Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable localized episodes of edema, which is frequently managed with long-term prophylactic medications. Until recently, long-term prophylaxis has predominantly required regular intravenous or subcutaneous administration, however the recent approval of berotralstat (Orladeyo™) offers an orally administered prophylactic which may be associated with a lower burden of treatment compared to injectable options for some patients. Case presentation This report describes four participants in the APeX-S trial who transitioned from subcutaneously administered lanadelumab (Takhzyro®) to daily oral berotralstat for long-term HAE prophylaxis. Lanadelumab dosing continued after berotralstat commencement in all patients and was tapered before discontinuation in three of the four patients. No substantial increases in HAE attack rates were observed after the transition to berotralstat monotherapy. One patient experienced a treatment-related adverse event (dyspepsia), which was mild and self-resolving. Conclusions All four patients described in this case series successfully transitioned from lanadelumab to berotralstat monotherapy for long-term prophylaxis without significant complications and without the use of a complex transition protocol. The decision to transition to berotralstat monotherapy and how the transition should be achieved was discussed between patient and physician, ensuring that the comfort and perspectives of the patients were considered during the treatment transition. This report highlights the importance of individualization of HAE management plans to address both the disease and treatment burdens of HAE, and thus to provide the best possible quality of life for each patient.https://doi.org/10.1186/s13223-021-00603-9Hereditary angioedemaTreatment burdenQuality of lifeProphylactic treatmentShared decision-makingBerotralstat |
| spellingShingle | Richard G. Gower Mary Wilber Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema Allergy, Asthma & Clinical Immunology Hereditary angioedema Treatment burden Quality of life Prophylactic treatment Shared decision-making Berotralstat |
| title | Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| title_full | Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| title_fullStr | Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| title_full_unstemmed | Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| title_short | Considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| title_sort | considerations for transition from subcutaneous to oral prophylaxis in the treatment of hereditary angioedema |
| topic | Hereditary angioedema Treatment burden Quality of life Prophylactic treatment Shared decision-making Berotralstat |
| url | https://doi.org/10.1186/s13223-021-00603-9 |
| work_keys_str_mv | AT richardggower considerationsfortransitionfromsubcutaneoustooralprophylaxisinthetreatmentofhereditaryangioedema AT marywilber considerationsfortransitionfromsubcutaneoustooralprophylaxisinthetreatmentofhereditaryangioedema |