Managing HAE Attacks: Patient Behavior and the Decision to Treat

Welcome back to Swell Conversations: A Promotional HAE Series! John Anderson, MD, clinical assistant professor at The University of Alabama at Birmingham and partner at AllerVie Health, returns to chat with Andrew Smith, MD, MS, owner and physician at Allergy Associates of Utah, about emerging topics in the management of hereditary angioedema (HAE). This episode explores the decision-making patterns of patients who are considering the use of an on-demand HAE treatment and examines practical approaches to patient conversations, including navigating discussions about treatment decisions and encouraging adherence to published guidelines. Last, Drs Anderson and Smith discuss the possible role that RUCONEST® (C1 esterase inhibitor [recombinant]) may play in HAE management.   WHAT IS RUCONEST?  RUCONEST® (C1 esterase inhibitor[recombinant]) is indicated for the treatment of acute attacks in adult and adolescent patients with hereditary angioedema (HAE). Effectiveness in clinical studies was not established in HAE patients with laryngeal attacks.  IMPORTANT SAFETY INFORMATION  RUCONEST is contraindicated in patients with a history of allergy to rabbits or rabbit-derived products and for patients with a history of life-threatening immediate hypersensitivity reactions, including anaphylaxis, to C1 esterase inhibitor (C1-INH) preparations.  Monitor patients for early signs of allergic or hypersensitivity reactions (including hives, generalized urticaria, tightness of the chest, wheezing, hypotension, and/or anaphylaxis). If symptoms occur, discontinue RUCONEST and administer appropriate treatment.  Serious arterial and venous thromboembolic (TE) events have been reported with plasma-derived C1-INH products. Risk factors may include the presence of an indwelling venous catheter/access device, prior history of thrombosis, underlying atherosclerosis, use of oral contraceptives or certain androgens, morbid obesity, and immobility. Monitor patients with known risk factors for TE events during and after RUCONEST administration.  Appropriately trained patients may self-administer RUCONEST upon recognition of an HAE attack. Advise patients to seek medical attention if progress of any attack makes them unable to properly prepare or administer a dose of RUCONEST. No more than 2 doses should be administered within a 24-hour period.   The serious adverse reaction reported in clinical trials was anaphylaxis. The most common adverse reactions (incidence ≥2%) were headache, nausea, and diarrhea.   Before prescribing RUCONEST, please read the full Prescribing Information including the Patient Product Information.  DISCLAIMER  This educational program is sponsored by Pharming Healthcare, Inc. The speakers have been compensated for the presentation of this information. The information contained within this podcast is for educational purposes only and is not intended to be medical advice. Patient experiences may be discussed in this episode. It is important to recognize that these experiences may not be representative, as every patient has a unique disease course. This activity is not intended for Continuing Medical Education credits.   EPISODE REFERENCE LIST  Maurer M, Magerl M, Betschel S, et al. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update. Allergy. 2022;77(7):1961-1990. doi:10.1111/all.15214   Busse PJ, Christiansen SC, Riedl MA, et al. US HAEA Medical Advisory Board 2020 guidelines for the management of hereditary angioedema. J Allergy Clin Immunol Pract. 2021;9(1):132-150.e3. doi:10.1016/j.jaip.2020.08.046  Christiansen S, O’Connor M, Ulloa J, et al. Delayed on-demand treatment of hereditary angioedema attacks: patient perceptions and associated barriers. Poster presented at: 2024 HAEi Regional Conference Americas; March 15-17, 2024; Panama City, Panama.  Sicherer SH, Simons FER; Section on Allergy and Immunology. Epinephrine for first-aid management of anaphylaxis. Pediatrics. 2017;139(3):e20164006. doi:10.1542/peds.2016-4006  Kaplan AP, Kusumam J. Pathogenesis of hereditary angioedema: the role of bradykinin-forming cascade. Immunol Allergy Clin North Am. 2017;37(3):513-525. doi:10.1016/j.iac.2017.04.001  Fields T, Ghebrehiwet B, Kaplan AP. Kinin formation in herediatry angioedema plasma: evidence against kinin derivation from C2 and in support of “spontaneous” formation of bradykinin. J Allergy Clin Immunol. 1983;72(1):54-60. doi:10.1016/0091-6749(83)90052-0  Ruconest. Prescribing Information. Pharming Healthcare, Inc; 2020.  Riedl MA, Bernstein JA, Li H, et al; Study 1310 Investigators. Recombinant human C1-esterase inhibitor relieves symptoms of hereditary angioedema attacks: phase 3, randomized, placebo-controlled trial. Ann Allergy Asthma Immunol. 2014;112(2):163-169.e1. doi:10.1016/j.anai.2013.12.004  Zuraw B, Cicardi M, Levy RJ, et al. Recombinant human C1-inhibitor for the treatment of acute angioedema attacks in patients with hereditary angioedema. J Allergy Clin Immunol. 2010;126(4):821-827.e14. doi:10.1016/j.jaci.2010.07.021 RUC-US-2025-0044