EASSI - Evaluation of the Safety of Self-Administration With Icatibant (EASSI)

Open Label, Multicenter Study to Evaluate Safety, Local Tolerability, Convenience, and Efficacy of a Self-Administered Subcutaneous Formulation of Icatibant for the Treatment of Acute Attacks of Hereditary Angioedema

This study is being conducted to explore the clinical safety, local tolerability, convenience and effectiveness of self-treatment of hereditary angioedema (HAE) attacks with subcutaneous injections of icatibant.

Study Overview

• Status: Completed
• Conditions: Hereditary Angioedema
• Intervention / Treatment: Drug: Icatibant

Detailed Description

This Phase IIIb study was multi-center and open-label with a single dose level. Subjects with a documented diagnosis of HAE Type I or II were eligible to participate in this trial. Eligible subjects included those who had received treatment for HAE with icatibant in previous clinical trials, or subjects who had been previously treated with the marketed product Firazyr® and subjects who were naïve to icatibant treatment.

All subjects were trained on the method of self-administration at their enrollment visit (Visit 1).For the training sessions, a syringe pre-filled with 3 mL placebo solution was used in place of icatibant. Comprehensive educational material and instructions including pictograms were developed for the subjects to illustrate the method of self-administration and use of the Patient Diary. The training material provided additional information on how to self-diagnose an HAE attack and how to decide on the necessity to treat.In addition, instructions were provided on what to do in case of a laryngeal attack.

• Study Type: Interventional
• Enrollment (Actual): 151
• Phase: Phase 3

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina, C1035AAT
    • Hospital Britanico Unidad de Alergia
• Austria
  • Graz, Austria, 8036
    • Universitätsklinik für Dermatologie und Venerologie
• Denmark
  • I Og Alergicentret
    • Odense, I Og Alergicentret, Denmark
      • Odense Universitetshospital-OUH
• France
  • Angers Cedex 09
    • Angers, Angers Cedex 09, France, 49933
      • Centre Hospitalier Universitaire/ Service de Dermatologie
  • Cedex 03
    • Lyon, Cedex 03, France, 69437
      • Hospital Edouaed Herriot
  • Grenoble Cedex 09
    • Grenoble, Grenoble Cedex 09, France, 38043
      • Clinique Universitaire de Medicine/ Centre National de reference
  • Lille Cedex
    • Lille, Lille Cedex, France, 59037
      • Hopital Claude Huriex/ Service de medicine interne
  • Paris Cedex 15
    • Paris, Paris Cedex 15, France, 75015
      • Hopital Europeen Georges Pompidou Immunologie Clinique
• Germany
  • Berlin, Germany, 10117
    • Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergologie, Charité
  • Essen, Germany, 45127
    • Universitäts-Hals-Nasen-Ohren-Klinik Essen, Universität Duisburg-Essen
  • Frankfurt am Main, Germany, 60590
    • Klinkum der Johann Wolfgang Goethe-Universitat
  • Mainz, Germany, 55101
    • Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität
• Israel
  • Haifa, Israel, 31048
    • Bnai-Zion M.C. Clinical Immunology and Allergy Division
  • Tel Aviv, Israel, 64239
    • Tel Aviv Sourasky Medical Center - Allergy Unit
  • Tel Hashomer, Israel, 52621
    • The Chaim Sheba Medical Center, The Allergy and Clinical Immunology Unit
• Italy
  • Milano, Italy, 20157
    • Ospedale Luigi Sacco
  • Napoli,, Italy, 80131
    • Università degli Studi di Napoli 'Federico II'
• Spain
  • Barcelona, Spain, 08035
    • Hospital Universitario Vall de Hebrón / Sección de Alergia, Escola Infermeria
  • Madrid, Spain, 28007
    • Hospital General Universitario Gregorio Marañon
  • Madrid, Spain, 28046
    • Hospital Universitario La Paz, Servicio de Alergia
  • Valencia, Spain, 46009
    • Hospital Universitario La Fe, Servicio de Alergia
• Switzerland
  • Luzern, Switzerland
    • Luzerner Kantonsspital
  • Zurich, Switzerland, 8091
    • Universitätsspital Zürich / Dermatologische Klinik
• United Kingdom
  • Bristol, United Kingdom, BS10 5NB
    • Southmead Hospital, Department of Immunology
  • London, United Kingdom, E1 2ES
    • Barts & The London NHS Trust, Pathology and Pharmacy Building
  • Plymouth, United Kingdom, PL6 8DH
    • Derriford Combined Laboratory, Department of Clinical Immunology & Allergy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Each patient must meet the following criteria to be enrolled in this study.

1. Males and females 18 years of age at the time of informed consent

2. Documented diagnosis of HAE Type I or II based on ALL of the following criteria:

   • Family and/or medical history
   • Characteristic attack manifestations, recurrent attacks
   • Historical functional C1-INH <50% normal values
3. Women of childbearing potential must use consistently and correctly a highly effective, adequate method of birth control (failure rate less than 1% per year) - sexual abstinence or have a vasectomised partner during the duration of the study. Hormonal contraception can be continued if verified by a physician that it doesn't affect the course of HAE attacks.
4. Mental and physical condition allowing patients to complete baseline assessment, to self-administer icatibant and to follow other study procedures.
5. Ability to provide signed written informed consent after all aspects of the study have been explained and discussed with the patient.

Exclusion Criteria:

Patients who meet any of the following criteria will be excluded from the study.

1. Participation in a clinical trial of another investigational medicinal product within the past month (except a previous icatibant study).
2. Diagnosis of angioedema other than Type I or Type II HAE.
3. Evidence of symptomatic coronary artery disease based on medical history, in particular, unstable angina pectoris or severe coronary heart disease.
4. Congestive heart failure (NYHA Class 3 and 4).
5. Stroke within the past 6 months.
6. Treatment with angiotensin converting enzyme (ACE) inhibitor.
7. Pregnancy and/or breast-feeding.
8. In the opinion of the investigator: mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study.
9. In the opinion of the investigator: unlikely to comply with the protocol, for example, uncooperative attitude, inability to return for follow-up visits, or unlikely to complete the study for any reason.
10. In the opinion of the investigator: inability to manage study medication or self-administration of an injection.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Icatibant- Naive Treatment Phase; Single subcutaneous injection of icatibant, 30 mg	Drug: Icatibant; Single subcutaneous injection of icatibant, 30 mg; Other Names: Brand name, Firazyr®
Experimental: icatibant- Self administration Phase; Single subcutaneous injection of icatibant, 30 mg	Drug: Icatibant; Single subcutaneous injection of icatibant, 30 mg; Other Names: Brand name, Firazyr®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Adverse Events in Self-treatment of Acute HAE Attacks With s.c. Injections of Icatibant	Clinical safety of self-treatment of acute HAE attacks with s.c. injections of icatibant was assessed by calculating the number of AEs occurred during the study. Only those adverse events occurring up to the earlier of 7 days from the start of the naive phase, study discontinuation and start of the self-administration phase are assessed. The Local Tolerability Assessment tool was used. Subjects and Investigators graded erythema/reddening, swelling, burning, pruritus/itching, warm sensation, and skin pain on a 0 to 3 severity scale.	7 days from the beginning of each phase

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Efficacy of Self-treatment of Acute HAE Attacks With s.c. Injections of Icatibant, Time to Symptom Relief Using VAS Score for a Single Primary Symptom by Patient Cohort	Subjects assessed angioedema attack symptoms using the visual analogue scale (VAS) for skin pain, skin swelling and abdominal pain. The VAS is a continuous scale comprised of a 100 mm in length line, anchored by 2 verbal descriptors, one for each symptom extreme 0 (no pain) and 100 (worst pain). The respondent is asked to place a mark on the VAS line (any where between 0 and 100 mm) at the point that represents their pain intensity. The score is determined by measuring the distance (mm) on the line between the "no pain" anchor and the patient's mark, providing a range of scores from 0-100. A higher score indicates greater pain intensity. Score interpretation is: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm). Symptom relief is defined as at least a 50% reduction in a pre-dose VAS score of 30 mm or greater. The time to onset of symptom relief is defined as the first of 3 consecutive assessments at which symptom relief was observed.	48 hours post-dose

Collaborators and Investigators

• Sponsor: Shire
• Collaborators: Jerini AG

Publications and helpful links

General Publications

• Aberer W, Maurer M, Reshef A, Longhurst H, Kivity S, Bygum A, Caballero T, Bloom B, Nair N, Malbran A. Open-label, multicenter study of self-administered icatibant for attacks of hereditary angioedema. Allergy. 2014 Mar;69(3):305-14. doi: 10.1111/all.12303.

Study record dates

Study Major Dates

• Study Start (Actual): September 25, 2009
• Primary Completion (Actual): June 22, 2011
• Study Completion (Actual): June 22, 2011

Study Registration Dates

• First Submitted: October 16, 2009
• First Submitted That Met QC Criteria: October 16, 2009
• First Posted (Estimate): October 19, 2009

Study Record Updates

• Last Update Posted (Actual): June 11, 2021
• Last Update Submitted That Met QC Criteria: June 1, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: HAE; Type I HAE; Type II HAE
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Skin Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Hypersensitivity, Immediate; Genetic Diseases, Inborn; Skin Diseases, Vascular; Hypersensitivity; Urticaria; Hereditary Complement Deficiency Diseases; Primary Immunodeficiency Diseases; Angioedema; Angioedemas, Hereditary; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Immunosuppressive Agents; Immunologic Factors; Complement Inactivating Agents; Bradykinin B2 Receptor Antagonists; Bradykinin Receptor Antagonists; Icatibant
• Other Study ID Numbers: JE049-3101; 2008-000071-25 (EudraCT Number)