A comprehensive literature search did not yield direct comparative data between Kalbitor (ecallantide) and Firazyr (icatibant) for the treatment of ACE inhibitor (ACEi)-induced angioedema. While ecallantide has been studied in ACEi-induced angioedema patients, data does not demonstrate significant benefit. In contrast, icatibant has been associated with faster symptom resolution and quicker onset of relief compared to placebo, along with a higher percentage of complete resolution (see Table 1...
A 2018 systematic review evaluated the efficacy of icatibant, ecallantide, and tranexamic acid (TA) for angiotensin-converting enzyme inhibitor (ACEi) induced and idiopathic angioedema (non-hereditary AE). This systematic review included 61 studies with 38 describing treatment in the acute setting, although the majority of evidence was case reports. There were no direct comparisons between icatibant, ecallantide, or TA. For ACEi-induced AE, two randomized controlled studies of ecallantide do not suggest a significant benefit based on response rate versus placebo (10%-16% response rate). Icatibant may have similar efficacy to C1NH and fresh frozen plasma (FFP) with an average response time of less than 2 hours, but the majority of included studies were not controlled and of lower quality. Data for TA in ACEi-induced AE was not available. [1]
For idiopathic AE, a single study on TA use observed a 54% response rate (13 to 24 patients). Data for icatibant and ecallantide are limited ...
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A search of the published medical literature revealed
2 studies investigating the researchable question:
is there comparative data supporting efficacy for Kalbitor (ecallantide) vs Firazyr (icatibant) for ACE inhibitor-induced angioedema?
Level of evidence
C - Multiple studies with limitations or conflicting results
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[1] van den Elzen M, Go MFCL, Knulst AC, Blankestijn MA, van Os-Medendorp H, Otten HG. Efficacy of Treatment of Non-hereditary Angioedema. Clin Rev Allergy Immunol. 2018;54(3):412-431. doi:10.1007/s12016-016-8585-0
[2] Caballero T, Pedrosa M. Angioedema due to ace inhibitors. Curr Treat Options Allergy. 2016;3(4):401-415. doi:10.1007/s40521-016-0099-8
[3] Scalese MJ, Reinaker TS. Pharmacologic management of angioedema induced by angiotensin-converting enzyme inhibitors. Am J Health Syst Pharm. 2016;73(12):873-879. doi:10.2146/ajhp150482