Hereditary Angioedema (HAE)
Conditions
Keywords
Firazyr, Angioedema, Angioedemas, Hereditary, Vascular Diseases, Cardiovascular Diseases, Urticaria, Skin Diseases, Vascular, Skin Diseases, Hypersensitivity, Immediate, Hypersensitivity, Immune System Diseases, Genetic Diseases, Inborn, Icatibant, Anti-Inflammatory Agents, Non-Steroidal, Analgesics, Non-Narcotic, Analgesics, Sensory System Agents, Peripheral Nervous System Agents, Physiological Effects of Drugs, Pharmacologic Actions, Anti-Inflammatory Agents, Therapeutic Uses, Antirheumatic Agents, Adrenergic beta-Antagonists, Adrenergic Antagonists, Adrenergic Agents, Neurotransmitter Agents, Molecular Mechanisms of Pharmacological Action, Central Nervous System Agents
Brief summary
This is a single-dose study to evaluate the pharmacokinetics, safety, and tolerability of icatibant administered to adult Japanese subjects.
Detailed description
Icatibant has been studied for the treatment of acute attacks of hereditary angioedema (HAE), an autosomal dominant disorder characterized by recurrent and self-limiting episodes of edema of the skin, larynx, and gastrointestinal tract. The most serious manifestation of an HAE attack is laryngeal edema, causing obstruction of the upper airways that may lead to death by asphyxiation if undiagnosed and/or untreated. Icatibant has been approved in over 40 countries around the world including the United States (US) and Europe for the treatment of acute attacks of hereditary angioedema (HAE) in adults. This study is being conducted to evaluate the safety and tolerability of icatibant in a Japanese population and to evaluate whether race/ethnicity impacts the pharmacokinetics of icatibant after single subcutaneous injection. This is an open-label, single-arm study that will enroll at least 12 Japanese subjects (in order to have 12 subjects complete the study), age 18-55 years inclusive. All subjects will receive a single subcutaneous injection of 30mg icatibant. The study will be conducted at 1 site in the US. The study will consist of a Screening Period, a Treatment Period, and a Follow-Up Period.
Interventions
On Day 1, subjects will receive a single 30mg subcutaneous injection of icatibant in their abdominal area. Subjects will be discharged from the study on Day 3 after collection of study related assessments
Sponsors
Study design
Eligibility
Inclusion criteria
1. Healthy male and female volunteers, 18 to 55 years of age, inclusive; healthy status defined as absence of clinically significant findings in medical history or screening assessments 2. Japanese; defined as born in Japan, lived outside of Japan for no more than 10 years, and having Japanese parents and Japanese maternal and paternal grandparents 3. Body mass index of 18 to 28 kg/m2, inclusive
Exclusion criteria
1. History of, or current, clinically significant disease and/or abnormalities 2. Smoking habit in excess of 5 cigarettes per day or the equivalent within 30 days of Day 1 or inability to refrain from smoking during the study confinement period 3. Subject has current abnormal thyroid function, as defined as abnormal screening thyroid stimulating hormone (TSH) and free thyroxine (T4). Treatment with a stable dose of thyroid medication for at least 12 weeks is permitted 4. History of drug allergy or other allergy that, in the opinion of the investigator, contraindicates participation 5. Male subjects who consume more than 21 units of alcohol per week or 3 units per day. Female subjects who consume more than 14 units of alcohol per week or 2 units per day. (1 alcohol unit =1 beer or =1 wine (5oz/150mL) or =1 liquor (1.5oz/40mL) or =0.75oz alcohol) 6. Routine consumption of more than 2 units of caffeine per day or subjects who experience caffeine withdrawal headaches. (1 caffeine unit is contained in the following items: one 6oz (180mL) cup of coffee, two 12oz (360mL) cans of cola, one 12oz cup of tea, three 1oz (85g) chocolate bars. Decaffeinated coffee, tea, or cola are not considered to contain caffeine) 7. Current use of any medication (including over-the-counter, herbal, or homeopathic preparations) with the exception of female hormonal replacement therapy or hormonal contraceptives. Occasional use of over-the-counter doses of ibuprofen or acetaminophen for minor self-limited pain (eg, headaches) is also acceptable. Current use is defined as use within 7 days of the first dose of investigational product\\ 8. Pregnant or lactating females
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Area Under the Plasma Concentration-Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Icatibant and Metabolites | Over 48 hours post-dose | AUC0-t is the area under the plasma concentration versus time curve extrapolated from time 0 to to the last quantifiable concentration. AUC can be used as a measure of drug exposure. It is derived from drug concentration and time so it gives a measure how much and how long a drug stays in a body. |
| Peak Plasma Concentration (Cmax) of Icatibant and Metabolites | Over 48 hours post-dose | Cmax is a term that refers to the maximum (or peak) concentration that a drug achieves in the body after the drug has been administrated. |
| Time to Peak Plasma Concentration (Tmax) of Icatibant and Metabolites | Over 48 hours post-dose | Tmax is the time after administration of a drug when the maximum plasma concentration in the body is reached. |
| Drug Concentration Half-Life (T1/2) of Icatibant and Metabolites | Over 48 hours post-dose | The time it takes for the blood plasma concentration of a substance to halve. |
| Area Under the Plasma Concentration-time Curve (AUC) From Time Zero to Infinity (AUCinf) of Icatibant and Metabolites | Over 48 hours post-dose | AUCinf is the area under the plasma concentration versus time curve extrapolated from time 0 to infinity, calculated using the observed value of the last non-zero concentration. AUC can be used as a measure of drug exposure. It is derived from drug concentration and time so it gives a measure how much and how long a drug stays in a body. |
| Total Body Clearance (CL/F) of Icatibant | Over 48 hours post-dose | The rate at which a drug is removed from the body. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Total Number of Treatment-Emergent Adverse Events | TEAEs were collected after the single dose of icatibant until follow up, 5-7 days after icatibant administration | Treatment-emergent adverse events (TEAEs) were those that started after the single dose of icatibant. |
| The Percentage of Subjects With Any Injection Site Reactions. | Over 48 hours post-dose | — |
| Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Over 48 hours post-dose | — |
| Change From Baseline in Diastolic Blood Pressure | Over 48 hours post-dose | — |
| Change From Baseline in Systolic Blood Pressure | Over 48 hours post-dose | — |
| Change From Baseline in Pulse Rate | Over 48 hours post-dose | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Icatibant (30 mg) Subjects received a 30mg dose of icatibant administered as a single subcutaneous injection in the abdominal area on Day 1. | 12 |
| Total | 12 |
Baseline characteristics
| Characteristic | Icatibant (30 mg) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 12 Participants |
| Age, Continuous | 30.7 years STANDARD_DEVIATION 8.08 |
| Region of Enrollment United States | 12 Participants |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 2 / 12 |
| serious Total, serious adverse events | 0 / 12 |
Outcome results
Area Under the Plasma Concentration-time Curve (AUC) From Time Zero to Infinity (AUCinf) of Icatibant and Metabolites
AUCinf is the area under the plasma concentration versus time curve extrapolated from time 0 to infinity, calculated using the observed value of the last non-zero concentration. AUC can be used as a measure of drug exposure. It is derived from drug concentration and time so it gives a measure how much and how long a drug stays in a body.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Area Under the Plasma Concentration-time Curve (AUC) From Time Zero to Infinity (AUCinf) of Icatibant and Metabolites | Icatibant | 2320 ng*hr/mL | Standard Deviation 403 |
| Icatibant (30 mg) | Area Under the Plasma Concentration-time Curve (AUC) From Time Zero to Infinity (AUCinf) of Icatibant and Metabolites | Metabolite 1 | 1750 ng*hr/mL | Standard Deviation 308 |
| Icatibant (30 mg) | Area Under the Plasma Concentration-time Curve (AUC) From Time Zero to Infinity (AUCinf) of Icatibant and Metabolites | Metabolite 2 | 1960 ng*hr/mL | Standard Deviation 346 |
Area Under the Plasma Concentration-Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Icatibant and Metabolites
AUC0-t is the area under the plasma concentration versus time curve extrapolated from time 0 to to the last quantifiable concentration. AUC can be used as a measure of drug exposure. It is derived from drug concentration and time so it gives a measure how much and how long a drug stays in a body.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Area Under the Plasma Concentration-Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Icatibant and Metabolites | Icatibant | 2320 ng*hr/mL | Standard Deviation 402 |
| Icatibant (30 mg) | Area Under the Plasma Concentration-Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Icatibant and Metabolites | Metabolite 1 | 1740 ng*hr/mL | Standard Deviation 307 |
| Icatibant (30 mg) | Area Under the Plasma Concentration-Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Icatibant and Metabolites | Metabolite 2 | 1950 ng*hr/mL | Standard Deviation 345 |
Drug Concentration Half-Life (T1/2) of Icatibant and Metabolites
The time it takes for the blood plasma concentration of a substance to halve.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Drug Concentration Half-Life (T1/2) of Icatibant and Metabolites | Metabolite 1 | 3.69 hr | Standard Deviation 0.579 |
| Icatibant (30 mg) | Drug Concentration Half-Life (T1/2) of Icatibant and Metabolites | Icatibant | 1.77 hr | Standard Deviation 0.356 |
| Icatibant (30 mg) | Drug Concentration Half-Life (T1/2) of Icatibant and Metabolites | Metabolite 2 | 4.11 hr | Standard Deviation 1.01 |
Peak Plasma Concentration (Cmax) of Icatibant and Metabolites
Cmax is a term that refers to the maximum (or peak) concentration that a drug achieves in the body after the drug has been administrated.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Peak Plasma Concentration (Cmax) of Icatibant and Metabolites | Icatibant | 1190 ng/mL | Standard Deviation 261 |
| Icatibant (30 mg) | Peak Plasma Concentration (Cmax) of Icatibant and Metabolites | Metabolite 1 | 340 ng/mL | Standard Deviation 67.7 |
| Icatibant (30 mg) | Peak Plasma Concentration (Cmax) of Icatibant and Metabolites | Metabolite 2 | 365 ng/mL | Standard Deviation 74.8 |
Time to Peak Plasma Concentration (Tmax) of Icatibant and Metabolites
Tmax is the time after administration of a drug when the maximum plasma concentration in the body is reached.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Time to Peak Plasma Concentration (Tmax) of Icatibant and Metabolites | Icatibant | 0.67 hr | Standard Deviation 0.2 |
| Icatibant (30 mg) | Time to Peak Plasma Concentration (Tmax) of Icatibant and Metabolites | Metabolite 1 | 1.92 hr | Standard Deviation 0.289 |
| Icatibant (30 mg) | Time to Peak Plasma Concentration (Tmax) of Icatibant and Metabolites | Metabolite 2 | 1.92 hr | Standard Deviation 0.289 |
Total Body Clearance (CL/F) of Icatibant
The rate at which a drug is removed from the body.
Time frame: Over 48 hours post-dose
Population: The Pharmacokinetic Set consisted of all subjects who had taken the single dose of icatibant and for whom the primary pharmacokinetic data were considered sufficient and interpretable.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Icatibant (30 mg) | Total Body Clearance (CL/F) of Icatibant | 13200 mL/hr | Standard Deviation 1890 |
Change From Baseline in Diastolic Blood Pressure
Time frame: Over 48 hours post-dose
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 12 h | -3.4 mmHg | Standard Deviation 9.06 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 2, 24 h | -1.8 mmHg | Standard Deviation 7.76 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 2 h | -5.2 mmHg | Standard Deviation 4.57 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 0.5 h | -2.0 mmHg | Standard Deviation 6.42 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 1 h | -3.8 mmHg | Standard Deviation 4.3 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 4 h | -5.2 mmHg | Standard Deviation 7.52 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 6 h | -4.8 mmHg | Standard Deviation 8.07 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 1, 8 h | -4.5 mmHg | Standard Deviation 6.67 |
| Icatibant (30 mg) | Change From Baseline in Diastolic Blood Pressure | Day 3, 48 h | -5.3 mmHg | Standard Deviation 6.18 |
Change From Baseline in Pulse Rate
Time frame: Over 48 hours post-dose
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 0.5 h | 1.4 beats per minute | Standard Deviation 7.53 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 1 h | 0.1 beats per minute | Standard Deviation 5.38 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 2 h | -3.0 beats per minute | Standard Deviation 9.67 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 4 h | -6.3 beats per minute | Standard Deviation 9.91 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 6 h | -0.1 beats per minute | Standard Deviation 11.15 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 8 h | -3.6 beats per minute | Standard Deviation 10.88 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 1, 12 h | -3.2 beats per minute | Standard Deviation 10.5 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 2, 24 h | -6.8 beats per minute | Standard Deviation 9.02 |
| Icatibant (30 mg) | Change From Baseline in Pulse Rate | Day 3, 48 h | -4.0 beats per minute | Standard Deviation 9.77 |
Change From Baseline in Systolic Blood Pressure
Time frame: Over 48 hours post-dose
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 0.5 h | -1.8 mmHg | Standard Deviation 12.07 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 1 h | -1.9 mmHg | Standard Deviation 13.03 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 2 h | -5.8 mmHg | Standard Deviation 14.21 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 4 h | -7.3 mmHg | Standard Deviation 17.06 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 6 h | -4.3 mmHg | Standard Deviation 16.2 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 8 h | -3.0 mmHg | Standard Deviation 11.52 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 1, 12 h | -4.4 mmHg | Standard Deviation 14.11 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 2, 24 h | -6.2 mmHg | Standard Deviation 11.98 |
| Icatibant (30 mg) | Change From Baseline in Systolic Blood Pressure | Day 3, 48 h | -6.4 mmHg | Standard Deviation 12.72 |
Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results
Time frame: Over 48 hours post-dose
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Screening | 91.67 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Day 1, Pre-dose | 50.00 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Baseline | 50.00 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Day 1, 0.75 hours | 33.33 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Day 1, 8 hours | 33.33 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Day 2, 24 hours | 66.67 percentage of participants |
| Icatibant (30 mg) | Safety Evaluation Measured by Percentage of Subjects With Not Clinically Significant Abnormalities in ECG Results | Day 3, 48 hours | 66.67 percentage of participants |
The Percentage of Subjects With Any Injection Site Reactions.
Time frame: Over 48 hours post-dose
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Erythema | 100.00 percentage of participants |
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Warm sensation | 50.00 percentage of participants |
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Swelling | 91.67 percentage of participants |
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Cutaneous pain | 33.33 percentage of participants |
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Itching/Pruritus | 8.33 percentage of participants |
| Icatibant (30 mg) | The Percentage of Subjects With Any Injection Site Reactions. | Burning sensation | 8.33 percentage of participants |
The Total Number of Treatment-Emergent Adverse Events
Treatment-emergent adverse events (TEAEs) were those that started after the single dose of icatibant.
Time frame: TEAEs were collected after the single dose of icatibant until follow up, 5-7 days after icatibant administration
Population: The Safety Set consisted of all subjects who had taken the single dose of icatibant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Icatibant (30 mg) | The Total Number of Treatment-Emergent Adverse Events | 2 Treatment Emergent Adverse Events |