It is hoped that recent research into expanding the use of a targeted, expensive drug could bring financial relief to many who share symptoms with those covered by the drug’s current restrictive application.
At issue are serious symptoms caused by ACE-inhibitor-induced angioedema. The drug studied is Icatibant (brand name Firazyr), but its only approved application at present is for Hereditary Angioneurotic Edema, or HAE — a rare, but significant disease.
People with HAE suffer repeated bouts of swelling (angioedema) of different body parts, from lips and tongue to throat and even the intestines. The attacks can be severe and occasionally life-threatening when the airway is compromised. They are caused by the build-up and release of bradykinin, a powerful vasodilator. Icatibant works by blocking the tissue receptor where bradykinin exerts its mischief.
Not so rare is ACE-inhibitor-induced angioedema, which also occurs because of a build-up and release of bradykinin. Unlike HAE in which any part of the body is susceptible to swelling, ACE angioedema tends to occur primarily around the head and neck — lips, tongue, face, palate and throat.
Also unlike HAE which is caused by a genetic deficiency in an enzyme, ACE angioedema is caused in susceptible individuals by the medications called ACE-inhibitors, which are antihypertensives. At the current time the only FDA-approved use of Icatibant is in HAE; therefore, using it in ACE-angioedema would be an “off-label” use.
Which comes around to the crazy world of insurance. At this point insurance carriers will only cover the cost (roughly $8,000 per dose) for people with HAE. Hopefully, this research study will change things, as ACE-angioedema is a common reason for emergency room visits.