Assessment of inhibitory antibodies in patients with hereditary angioedema treated with plasma-derived C1 inhibitor

Henriette Farkas, Lilian Varga, Dumitru Moldovan, Krystyna Obtulowicz, Todor Shirov, Thomas Machnig, Henrike Feuersenger, Jonathan Edelman, Debora Williams-Herman, Mikhail Rojavin

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Abstract

Background Limited data are available regarding C1 inhibitor (C1-INH) administration and anti–C1-INH antibodies. Objective To assess the incidence of antibody formation during treatment with pasteurized, nanofiltered plasma-derived C1-INH (pnfC1-INH) in patients with hereditary angioedema with C1-INH deficiency (C1-INH-HAE) and the comparative efficacy of pnfC1-INH in patients with and without antibodies. Methods In this multicenter, open-label study, patients with C1-INH-HAE (≥12 years of age) were given 20 IU/kg of pnfC1-INH per HAE attack that required treatment and followed up for 9 months. Blood samples were taken at baseline (day of first attack) and months 3, 6, and 9 and analyzed for inhibitory anti–C1-INH antibody (iC1-INH-Ab) and noninhibitory anti–C1-INH antibodies (niC1-INH-Abs). Results The study included 46 patients (69.6% female; mean age, 38.9 years; all white) who received 221 on-site pnfC1-INH infusions; most patients received 6 or fewer infusions. No patient tested positive (titer ≥1:50) for iC1-INH-Ab at any time during the study. Thirteen patients (28.2%) had detectable niC1-INH-Abs in 1 or more samples. Nine patients (19.6%) had detectable niC1-INH-Abs at baseline; 3 of these had no detectable antibodies after baseline. Of 10 patients (21.7%) with 1 or more detectable result for niC1-INH-Abs after baseline, 6 had detectable niC1-INH-Abs at baseline. Mean times to symptom relief onset and complete symptom resolution per patient were similar for those with or without anti–niC1-INH-Abs. Conclusion Administration of pnfC1-INH was not associated with iC1-INH-Ab formation in this population. Noninhibitory antibodies were detected in some patients but fluctuated during the study independently of pnfC1-INH administration and appeared to have no effect on pnfC1-INH efficacy. Trial Registration clinicaltrials.gov Identifier: NCT01467947.

Original languageEnglish
Pages (from-to)508-513
Number of pages6
JournalAnnals of Allergy, Asthma and Immunology
Volume117
Issue number5
DOIs
Publication statusPublished - Nov 1 2016

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

Cite this

Farkas, H., Varga, L., Moldovan, D., Obtulowicz, K., Shirov, T., Machnig, T., Feuersenger, H., Edelman, J., Williams-Herman, D., & Rojavin, M. (2016). Assessment of inhibitory antibodies in patients with hereditary angioedema treated with plasma-derived C1 inhibitor. Annals of Allergy, Asthma and Immunology, 117(5), 508-513. https://doi.org/10.1016/j.anai.2016.08.025