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Angiotensin Converting Enzyme Inhibitor Induced AngioedemaPhase 3NCT01919801

Blinded Safety & Efficacy Placebo Controlled Study of Icatibant for Angiotensin Converting Enzyme Inhibitor Induced Angioedema

A Phase 3 study testing Icatibant in people with Angiotensin Converting Enzyme Inhibitor Induced Angioedema, run by Shire at 55 sites in 4 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is being conducted to compare the safety and efficacy of icatibant with placebo in the treatment for Angiotensin-Converting Enzyme Inhibitor (ACE-I)-Induced Angioedema in Adults. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Icatibant
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
118 participants
Where
55 sitesin 4 countries
Study dates
2 Dec 2013to 22 Aug 2015
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Male or female, 18 years of age or older.
  • Patient is currently being treated with an ACE inhibitor.
  • Patient presenting with an ACE inhibitor-induced angioedema attack of the head and/or neck region within 12 hours of onset (must be sufficiently less than 12 hours to allow study drug to be given with 12 hours of attack onset).
  • Angioedema must be considered at least moderate in severity for at least one of the four angioedema-associated airway symptoms (difficulty breathing, difficulty swallowing, voice changes, tongue swelling).
  • Patient must have voluntarily signed an Institutional Review Board/Independent Ethics Committee-approved informed consent form after all relevant aspects of the study have been explained and discussed with the patient.
  • Females must have a negative urine pregnancy test prior to administration of the study medication, with the exception of those females who have had a total hysterectomy or bilateral oophorectomy, or who are 2 years post-menopausal.

Who cannot join

  • Patient has a diagnosis of angioedema of other etiology (eg, hereditary or acquired angioedema, allergic angioedema [eg, food, insect bite or sting, evident clinical response to antihistamines and/or corticosteroids], anaphylaxis, trauma, abscess or infection or associated disease, local inflammation, local tumor, post-operative or post-radiogenic edema, salivary gland disorders, other [non-ACE inhibitor] drug-induced angioedema).
  • Patients with a family history of recurrent angioedema.
  • Patients who have had a previous episode(s) of angioedema while not on ACE inhibitor therapy.
  • Patients with acute urticaria (itchy, erythematous wheals).
  • Patients who have an intervention to support the airway (eg, intubation, tracheotomy, cricothyrotomy) due to the current attack of angioedema.
  • Patient has any of the following vascular conditions that, in the judgment of the investigator, would be a contraindication to participation in the study.
Show all 16Show fewer
  • Unstable angina pectoris or acute myocardial ischemia
  • Hypertensive urgency or emergency (diastolic blood pressure [DBP] >120 mm Hg or systolic blood pressure [SBP] >180 mm Hg)
  • Within 1 month of a stroke or transient ischemic attack
  • New York Heart Association (NYHA) heart failure class IV
  • Patient has a serious or acute condition or illness that, in the judgment of the investigator, would interfere with evaluating the safety and/or efficacy assessments of the study (eg, a condition or illness requiring hemodialysis).
  • Patient is pregnant or breast feeding.
  • Patient has participated in another investigational study in the past 30 days.
  • Patient is unable to understand the nature, scope, and possible consequences of the protocol, or is unlikely or unable to comply with the protocol assessments, or is unlikely to complete the study for any reason.
  • Patients who are not suitable for the study in the opinion of the investigator.
  • Patient has experienced hypersensitivity to the active substance of the investigational product or to any of its excipients.

Trial locations and contacts

55 sites in 4 countries.

55 sites in 4 countries

United States43 sites
  • University of New Mexico

    Albuquerque, New Mexico, 87106

  • University of Maryland School of Medicine

    Baltimore, Maryland, 21201

  • Massachusetts General Hospital

    Boston, Massachusetts, 02114

  • Brigham and Womens Hospital

    Boston, Massachusetts, 02115

  • Kings County Hospital Center

    Brooklyn, New York, 11203

  • SUNY Downstate Medical Center

    Brooklyn, New York, 11203

  • Summit Health

    Chambersburg, Pennsylvania, 17201

  • University of Virginia

    Charlottesville, Virginia, 22903

  • Federal Health Care Center

    Chicago, Illinois, 60064-3048

  • Cook County Hospital

    Chicago, Illinois, 60612

  • University of Cincinnati

    Cincinnati, Ohio, 45219

  • Cleveland Clinic Foundation

    Cleveland, Ohio, 44195

  • University of South Carolina School of Medicine

    Columbia, South Carolina, 29203

  • Baylor University Medical Center

    Dallas, Texas, 75246

  • Detroit Receiving Hospital and University Health Center

    Detroit, Michigan, 48201

  • Sinai Grace Hospital

    Detroit, Michigan, 48201

  • Henry Ford Health System

    Detroit, Michigan, 48202

  • John Peter Smith Hospital

    Fort Worth, Texas, 76104

  • Ohio State University Hospital - East

    Gahanna, Ohio, 43230

  • UF Health Shands Hospital

    Gainesville, Florida, 32610

  • University of Texas Medical Branch

    Galveston, Texas, 77555-0561

  • East Carolina University

    Greenville, North Carolina, 27835

  • Baylor College of Medicine

    Houston, Texas, 77030

  • University of Kansas Cancer Center

    Kansas City, Kansas, 66160

  • University of California San Diego Medical Center

    La Jolla, California, 92037

  • University of California San Diego

    La Jolla, California, 92093

  • Hennepin County Medical Center

    Minneapolis, Minnesota, 55415

  • Ochsner Medical Center

    New Orleans, Louisiana, 70121

  • Weill Medical College of Cornell University

    New York, New York, 10021

  • Orlando Health

    Orlando, Florida, 32806

  • Hahnemann University Hospital

    Philadelphia, Pennsylvania, 19102

  • Temple University Hospital

    Philadelphia, Pennsylvania, 19140

  • Albert Einstein Medical Center

    Philadelphia, Pennsylvania, 19141

  • Allegheny General Hospital

    Pittsburgh, Pennsylvania, 15143

  • Rhode Island Hospital

    Providence, Rhode Island, 02903

  • William Beaumont Hospital

    Royal Oak, Michigan, 48073

  • Baystate Medical Center

    Springfield, Massachusetts, 01199

  • Barnes Jewish Hospital

    St Louis, Missouri, 63110

  • Washington University

    St Louis, Missouri, 63141

  • Tampa General Hospital

    Tampa, Florida, 33606

  • William Beaumont Hospital

    Troy, Michigan, 48085

  • Inspira Health Network

    Vineland, New Jersey, 08360

  • Washington Hospital Center

    Washington D.C., District of Columbia, 20010

Other trials in United States

United Kingdom5 sites
  • Brighton and Sussex University Hospitals NHS Trust

    Brighton, BN2 5BE

  • Royal Devon and Exeter Hospital NHS Trust

    Exeter, EX2 5DW

  • University Hospital Aintree

    Liverpool, L9 7AL

  • Manchester Royal Infirmary

    Manchester, M13 9WL

  • Queen's Medical Centre

    Nottingham, NG7 2UH

Other trials in United Kingdom

Israel4 sites
  • Soroka University Medical Center

    Beersheba, 84101

  • Bnai Zion Medical Center

    Haifa, 31048

  • Ziv Medical Center

    Safed, 13100

  • Tel-Aviv Sourasky Medical Center

    Tel Aviv, 64239

Other trials in Israel

Canada3 sites
  • Queen Elizabeth II Health Sciences Center

    Halifax, Nova Scotia, B3H 3A7

  • Kingston General Hospital

    Kingston, Ontario, K7L 2V7

  • Hotel Dieu Hospital

    Kingston, Ontario, K7L 5G2

Other trials in Canada

About this study

Official title: Phase III, Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Study Evaluating the Safety & Efficacy of Icatibant as a Treatment for Angiotensin-Converting Enzyme Inhibitor (ACE-I)-Induced Angioedema in Adults

This study is being conducted to compare the safety and efficacy of icatibant with placebo in the treatment for Angiotensin-Converting Enzyme Inhibitor (ACE-I)-Induced Angioedema in Adults.

Read the detailed description

Angiotensin-converting enzyme inhibitors (ACE-Is) are the class of medications prescribed most frequently for the treatment of hypertension. They are also used post myocardial infarction as well as in patients with heart failure, diabetes mellitus, and chronic kidney disease. Approximately 35 to 40 million patients are on ACE-Is worldwide.

Study HGT-FIR-096 is a multicenter, Phase III, randomized, double-blind, two-armed, placebo-controlled trial. The study population will consist of 118 adult patients, 18 years of age or older, who present with an acute ACE-I-induced angioedema attack. The primary aim of the study is to demonstrate that icatibant is significantly more effective than placebo in resolving attacks of angioedema caused by ACE-I based on the Time to Meeting Discharge Criteria (TMDC). Safety and tolerability, as well as the pharmacokinetics (PK), of icatibant will also be evaluated. Eligible patients will be randomized at a 1:1 ratio to receive a single sub-cutaneous injection of either 30 mg icatibant or placebo.

Being tested
Icatibant, Placebo
Keywords
icatibant, Firazyr, ACE-I

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • IcatibantDrug

    Also called Firazyr

    Single dose of 30 mg icatibant administered within 12 hours of the onset of an acute attack of ACE-I-induced angioedema

  • PlaceboDrug

Study groups in NCT01919801
Study groupRoleWhat they receive
IcatibantExperimentalIcatibant at a dose of 30 mg will be administered as a single subcutaneous injection
Receives: Drug: Icatibant
PlaceboPlacebo comparatorPlacebo will be administered as a single subcutaneous injection
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to Meeting Discharge Criteria (TMDC)

    TMDC was based on the investigator-assessed angioedema-associated upper airway symptom assessments. It was calculated from the time of study drug administration to the earliest time point at which the symptoms of difficulty breathing and difficulty swallowing were absent and the symptoms of voice change and tongue swelling were mild or absent and all subsequent assessments continued to satisfy these conditions. These symptoms were evaluated by the investigator using a 5-point grading scale (0=absent, 1=mild, 2=moderate, 3=severe, and 4=very severe). TMDC was analysed using Kaplan-Meier estimates.

    Measured: Day 0 up to Day 5

  2. Number of Participants With Treatment-emergent Adverse Events (TEAE) and Treatment-emergent Serious Adverse Events (TESAEs)

    An adverse event (AE) was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. An serious adverse event (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. TEAEs were defined as adverse events/serious adverse events that started or worsened after the study drug treatment.

    Measured: From start of study drug administration (Day 0) up to follow-up (Day 5)

  3. Number of Participants With Treatment Emergent Injection Site Reaction

    Injection site reaction included erythema, swelling, cutaneous pain, burning sensation, itching and warm sensation

    Measured: Day 0 to Day 5

  4. Number of Participants With Clinically Significant Changes in Laboratory Evaluation, Vital Signs, Electrocardiogram (ECG) and Physical Examination

    During laboratory evaluation, serum chemistry and hematology blood tests, and urinalysis were performed. Vital signs parameters included evaluation of pulse rate and systolic and diastolic blood pressure. Standard 12-lead ECGs were performed and ECG recordings were read locally at the study site by a cardiologist. Physical examination was performed with examination of major body systems per routine clinical practice.

    Measured: Day 0 to Day 5

Secondary outcomes (5)
  1. Time to Onset of Symptom Relief (TOSR)

    TOSR was calculated for the individual symptoms with pre-treatment scores of 2 (moderate) or more improved by at least 1 severity grade and the individual symptoms with pretreatment scores of 0 or 1 (absent or mild) were scored again at 0 or 1 and all the subsequent assessments continued to satisfy this condition. Time-to-event data were summarized using Kaplan-Meier estimates.

    Measured: Day 0 up to Day 5

  2. Number of Participants Experienced Airway Intervention Due to ACE-I-induced Angioedema

    Airway Intervention included intubation, tracheotomy, cricothyrotomy.

    Measured: Day 0 up to Day 5

  3. Number of Participants Admitted to Hospital or Intensive Care Unit (ICU)

    Number of participants with and without an occurrence of admission to the hospital (inpatient) or ICU post-treatment due to the ACE-I-induced angioedema attack were described.

    Measured: Day 0 up to Day 5

  4. Number of Participants Experienced ACE-I-induced Angioedema Attack Following Study Drug Administration

    Number of participants with the use of conventional medications (corticosteroids, antihistamines, epinephrine) for the treatment of symptoms of the ACE-I- induced angioedema attack following study drug administration were presented.

    Measured: Day 0 up to Day 5

  5. Percentage of Participants With Time to Meeting Discharge Criteria (TMDC) at Specified Time Points

    TMDC was based on the investigator-assessed angioedema-associated upper airway symptom assessments. It was calculated from the time of study drug administration to the earliest time point at which the symptoms of difficulty breathing and difficulty swallowing were absent and the symptoms of voice change and tongue swelling were mild or absent and all subsequent assessments continued to satisfy these conditions. These symptoms were evaluated by the investigator using a 5-point grading scale (0=absent, 1=mild, 2=moderate, 3=severe, and 4=very severe). TMDC was analysed using Kaplan-Meier estimates.

    Measured: 4, 6, and 8 hours post treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Aug 2013 (estimated)
  2. Study start2 Dec 2013
  3. Primary completion22 Aug 2015
  4. Study completion22 Aug 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
118 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01919801
Sponsor's protocol ID
HGT-FIR-096
Other IDs
2014-001213-12, 2014
Status last verified
May 2021
First submitted
25 Jul 2013
Last updated
8 Jun 2021
Data monitoring committee
Yes

Publications

  • Sinert R, Levy P, Bernstein JA, Body R, Sivilotti MLA, Moellman J, Schranz J, Baptista J, Kimura A, Nothaft W; CAMEO study group. Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor-Induced Upper Airway Angioedema. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1402-1409.e3. doi: 10.1016/j.jaip.2017.03.003. Epub 2017 May 25.

    PubMed 28552382

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Icatibant in people with Angiotensin Converting Enzyme Inhibitor Induced Angioedema, run by Shire at 55 sites in 4 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 55 sites in United States, United Kingdom, Israel, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Oct 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to Meeting Discharge Criteria (TMDC) (time frame: Day 0 up to Day 5). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01919801, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jun 2021.

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