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Overview of ecallantide in the treatment of hereditary angioedema types I and II

Erin Banta and Timothy J Craig

Hereditary angioedema is a rare disease characterized by unpredictable attacks of swelling in any anatomic location. Hereditary angioedema attacks lead to significant morbidity and can occasionally cause mortality. Treatment for acute attacks includes intravenous C1 esterase inhibitor replacement and, in Europe, subcutaneous bradykinin inhibitor (icatibant). In December 2009, a new medication aimed at the bradykinin cascade called ecallantide received approval from the US FDA for the treatment of acute attacks of hereditary angioedema. Ecallantide is a 60-amino acid recombinant protein that is a potent and specific plasma kallikrein inhibitor. Ecallantide is subcutaneously administered and not plasma derived. In the Phase III EDEMA3 and EDEMA4 studies, subjects treated with ecallantide had statistically significant evidence of clinical improvement at 4 and 24 h when compared with subjects treated with placebo. Ecallantide is an alternative to C1 esterase inhibitor and icatibant for the treatment of acute attacks of hereditary angioedema.