Pharmacotherapy for Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Systematic Review
Pharmacotherapy for Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Systematic Review
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DOI：
10.1177/0194599817737974
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发表时间：
2018-02-01
影响因子：
3.4
通讯作者：
McCoul, Edward D.
中科院分区：
文献类型：
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作者：
Lawlor, Claire M.;Ananth, Ashwin;McCoul, Edward D.
目标。血管性水肿是使用血管紧张素转换酶抑制剂（ACEI）的潜在危及生命的并发症，发生率高达0.5%。虽然acei诱导的血管性水肿的病理生理可归因于血清缓激肽升高，但标准的治疗通常包括皮质类固醇和抗组胺药。我们试图总结支持药物治疗acei诱导血管性水肿的证据。数据源。PubMed、MEDLINE和Embase门户。方法：根据PRISMA指南进行系统的文献综述。三位独立审稿人查询了数据库中1980年至2017年间发表的英语研究。最初的研究筛选了所有发生的血管性水肿，然后进一步细化到包括acei相关病例的研究，并排除了遗传性血管性水肿。共纳入5篇文章，共218例，包括3个随机对照试验和2个具有历史对照的前瞻性病例系列。两项研究中有一项研究发现伊卡伐特（缓激肽B2受体拮抗剂）的症状改善比皮质类固醇和抗组胺药的对照组更快。两项ecallantide（血浆钾激肽抑制剂）研究和一项C1抑制剂替代研究发现，与对照组相比，没有显著的益处。没有研究证实皮质类固醇与抗组胺药、一种剂量与另一种剂量、新鲜冷冻血浆或联合治疗的疗效。缓激肽拮抗剂、缓激肽抑制剂和C1抑制剂治疗acei诱导的血管性水肿的疗效有待进一步研究。虽然这些药物的持续益处尚未得到证实，但它们的使用并未造成伤害。一项研究检查了说明书外使用伊卡替班的疗效超过了控制。此外，糖皮质激素、抗组胺药等标准药物治疗的疗效和作用机制有待进一步研究。
Objective. Angioedema is a potentially life-threatening complication of angiotensin-converting enzyme inhibitor (ACEI) use, occurring in up to 0.5% of users. Although the pathophysiology of ACEI-induced angioedema is attributable to elevated serum bradykinin, standard management typically includes corticosteroids and antihistamines. We sought to summarize the evidence supporting pharmacotherapy for ACEI-induced angioedema.Data Sources. PubMed, MEDLINE, and Embase portals.Methods: A systematic literature review was conducted according to the PRISMA guidelines. Databases were queried by 3 independent reviewers for English-language studies published between 1980 and 2017. The initial search screened for all occurrences of angioedema and then was further refined to include studies of ACEI-related cases and exclude hereditary angioedema.Results. Five articles representing 218 cases were identified, including 3 randomized controlled trials and 2 prospective case series with historical controls. One of 2 studies of icatibant (bradykinin B2 receptor antagonist) found more rapid symptom improvement than that with a control group of corticosteroids and antihistamines. Two studies of ecallantide (plasma kallikrein inhibitor) and 1 study of C1 inhibitor replacement found no significant benefit over control. No studies were identified that compared the efficacy of corticosteroids with antihistamines, of one dose with another, of fresh frozen plasma, or of combination therapy.Conclusion. The efficacy of treatment of ACEI-induced angioedema with bradykinin antagonists, kallikrein inhibitor, and C1 inhibitor warrants further study. Although consistent benefit of these medications has not been demonstrated, their use has not caused harm. One study examining off-label use of icatibant has demonstrated efficacy over control. In addition, further study is needed to establish the efficacy and mechanism of action of standard pharmacotherapy such as corticosteroids and antihistamines in treatment of this condition.