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Welcome to CME on ReachMD. This episode is part of our MinuteCE curriculum. Prior to beginning the activity, please be sure to review the faculty and commercial support disclosure statements as well as the learning objectives.”  

Dr. Valerieva: 

Hello, everyone. This is CME on ReachMD, and I'm Dr. Anna Valerieva. And I'm going to be speaking today in this brief presentation for optimizing acute treatment of HAE in the era of breakthrough attacks. 

 So we all know what is HAE. It's an unpredictable disease affecting 1 in 50,000 people having attacks of angioedema in various location sites. We know that current guidelines suggest treatment of all angioedema attacks, and also we have long-term prophylaxis for those patients who have substantial disease burden due to impaired quality of life. So let's see what are the exact breakthrough attacks.  

 So the breakthrough attack is the one that occurs despite long-term prophylaxis, and it can severely impact quality of life, as well. So the causes of having thosebreakthrough attacks are really not very well understood. We know that they are a spontaneous breakthrough attacks, we know that there are genetic variability towards the response to the long-term therapies, and we have also specific factors, likeexternal triggers for having acute angioedema manifestations, like stress, trauma,different infections, or also, different aspectsthat lead to the delayed time between long-term prophylactic administrations. For example, having delayed injections in some patients who received injectable long-term prophylaxis. But also, we have some patients who are receiving oral agents that might also tend to have delayed administration or some of the doses being missed.  

 So the challenges come due to the unpredictability and potential severity of those breakthrough attacks. Also, we have facedlife-threatening laryngeal swellings in patients under long-term prophylaxis. So the dilemma comes for our patients who might find it, for sometimes, difficultto recognize the early signs of an acute angioedema manifestation, and we really do lack biomarkersbeing readily available and accessible for patients to recognize, as soon as possible, the acute angioedema attack.  

 Being physicians treating HAE,we know very well that the treatment of acute angioedema attacks should be as early as possible once the attack is recognized. So there is a high need for this earlytreatment,which canaugment faster symptom resolution,reduce attack duration, and of course, improve patient outcomes.  

 There is a certain risk of the so-called watch-and-wait approach, which is practiced by some of the patients, because we know that if an attack has progressedenough,we would need more timeto see the resolution as beingtime-affected by angioedema. So we need to act in this so-called window of opportunity in order to stop the attack once recognized. 

 So the currenttreatment options for acute angioedema attacksare the ones that are known to us forconventional on-demand therapies.We have available bradykinin B2 receptor and kallikrein-kinin inhibitor being subcutaneous agents. And we haveC1-inhibitor concentratesthat are delivered intravenouslywhen patients haveacute attacks.There is alwaysa benefit to promoting self-administrationcompared to healthcare provider administration, because we know that administration by healthcare providersmight take longer time.Thus, self-administrationcan potentially augmentquicker intervention and potentially, resolution of the symptoms.  

 Another point when speaking about breakthrough attacks, is to know thatwe, as physicians treating patients with HAE, we need to intervene once such attacks have been recognized as a pattern in specific patients. We need to always have this circle of review, act, monitor and educate our patients.Maybe, also, adjust the therapy,discuss different treatment options. Of course, taking into accountsuchan individualized approachthat can also implement the patient preferenceinthe treatment.  

 So in my concluding remarks, I'm going to be speaking about the importance ofpatient education,in order to facilitate our patients to bemore powerfulin order to treat as early as possible.Also, to recognize symptoms as early as possible, thus being more free to treat their acute angioedema once recognized. We need topotentially improve an individualized plan for each and every single patient,taking into account patient preferences. And of course,keep our strength to improve future research directions, to improve our treatment of HAE, and potentiallydeliver new therapies and strategies to improveHAE management globally.  

And with this,I'm going to beconcluding my lecture and wishing you all a great day. Thank you.  

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