Real-world Experience with Advanced Long-term Prophylaxis Agents to Treat Hereditary Angioedema in Canada

Authors

  • Jean-Nicolas Boursiquot, MD, FRCPC Centre Hospitalier Universitaire de Québec
  • Hugo Chapdelaine, MD, FRCPC Montreal Clinical Research Institution Department of Medicine, Université de Montréal

DOI:

https://doi.org/10.58931/cait.2025.5s0176

Abstract

Hereditary angioedema (HAE) is a rare genetic disorder caused by a deficiency or dysfunction in the serine protease inhibitor of C1, which results in an accumulation of the vasodilator bradykinin. Angioedema is a type of temporary swelling that can be histaminergic (mast cell-mediated) or non-histaminergic (bradykinin-mediated), of which HAE is an example. The prevalence of HAE is approximately 1:50,000 individuals, and no major differences in prevalence between ethnicities or sex have been reported for the most common subtypes I and II. There are three categories of HAE; type I is the most prevalent and is characterized by low C1-inhibitor (C1-INH) levels, type II ischaracterized by normal levels but low activity of C1-INH (dysfunctional C1-INH), and patients with the nC1-INH subtype have normal C1-inhibitor levels and function. This last subtype has an unknown prevalence, but is less commonly observed than type I and II.

The dysfunction or deficit in C1-INH results in accumulation of the vasodilator bradykinin. C1-INH is involved in inhibiting proteins in the bradykinin pathway, such as factor XIIa and kallikrein. Due to the overproduction of bradykinin, vascular permeability increases, resulting in recurrent episodes of potentially severe angioedema in various body parts (HAE attacks). HAE management includes acute attack management, and potentially short-term and/or long-term prophylaxis (LTP). This article will discuss disease burden, patient unmet needs, challenges with conventional treatments, and clinical trial and real-world experience with the newer LTP agents lanadelumab, berotralstat, and garadacimab, with a particular emphasis on Canadian experience with these newer drugs.

Author Biographies

Jean-Nicolas Boursiquot, MD, FRCPC, Centre Hospitalier Universitaire de Québec

Dr. Jean-Nicolas Boursiquot completed his medical degree and internal medicine specialty at Université Laval. He then completed postdoctoral training in clinical immunology and allergy at McGill University. He holds a Master's degree in Biomedical Sciences from the University of Montreal and is currently working as an allergist and clinical immunologist at the CHU de Quebec, where he also teaches residents in the allergy and immunology program. He was director of the Continuing Professional Development Committee of the Quebec Association of Allergists and Immunologists. In 2016, he participated in the adaptation of the ‘’Guide complet des allergies’’ published by Éditions Edito.

Hugo Chapdelaine, MD, FRCPC, Montreal Clinical Research Institution Department of Medicine, Université de Montréal

Dr. Hugo Chapdelaine completed his medical studies at the Université de Montréal, where he obtained a specialization in Clinical Immunology and Allergy. He also completed additional training in hematology at the Hôpital Necker (Paris). Dr. Chapdelaine is a specialist in clinical immunology. He is Director of the Primary Immunodeficiency Clinic of the Research Centre on Rare and Genetic Diseases in Adults at the Montreal Clinical Research Institute (IRCM) as well as research fellow at the Institute. Dr. Chapdelaine also practices as a physician at the Clinical Immunology and Allergy Services at the Centre hospitalier de l’Université de Montréal (CHUM) and as Associate Clinician at the Immunology, Rheumatology and Allergy Services at the Centre hospitalier universitaire Sainte-Justine (Montreal). In addition, he is Associate Clinical Professor at the Faculty of Medicine of Université de Montréal.

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Published

2025-03-19

How to Cite

1.
Boursiquot J-N, Chapdelaine H. Real-world Experience with Advanced Long-term Prophylaxis Agents to Treat Hereditary Angioedema in Canada. Can Allergy Immunol Today [Internet]. 2025 Mar. 19 [cited 2025 Apr. 2];5(s01):2–9. Available from: https://canadianallergyandimmunologytoday.com/article/view/5-s01-Boursiquot_et_al

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