Key result
In Thai patients with RAS blocker-associated angioedema, respiratory complications occurred in 5.1% of cases and were significantly associated with a history of allergy (adjusted OR 2.23; p=0.041).
Why the study?
What are the clinical characteristics and risk factors for severe complications of RAS blocker-associated angioedema in the Thai population?
Observational (n=895)
Yes
What are the clinical characteristics and risk factors for severe complications of RAS blocker-associated angioedema in the Thai population?
Odds Ratio: 2.23 (95% CI 1.04–4.78)
p-value: p=0.041
In a Thai national database, RAS blocker-associated angioedema occurred mostly in older females, often within the first week of treatment, with a history of allergy increasing the risk of respiratory complications.
May flag Thai patients with allergy history for closer monitoring of RAS blocker angioedema; leaves open generalizability and causality.
BACKGROUND: Renin-angiotensin-aldosterone system (RAS) blockers are commonly used for cardiovascular diseases. Currently, little information exists for the Asian population on angioedema, a rare yet serious adverse event. OBJECTIVE: This study aimed to describe characteristics of RAS blockers-associated angioedema (RASBA) in Thai patients. METHODS: A retrospective study using the national pharmacovigilance database of Thailand was undertaken. Cases indicating the presence of angioedema with RAS blockers uses from 1984-2011 were identified. Patient demographics, co-morbidities, concomitant drugs, information for the RAS blockers and angioedema were obtained as well as causality assessment and quality of reports. RESULTS: A total of 895 cases were identified. Mean age was 59.9+12.8 years and 66.5% being female. Most angioedema events (48.6%) occurred during the first week of treatment. Angiotensin converting enzyme inhibitors (87.7%) were the most commonly implicated agents followed by angiotensin receptor blockers (10.5%), aldosterone antagonist (2.1%) and direct renin inhibitor (0.2%). Out of the 895 cases incorporated in this study, 165 (18.4%) were classified as serious events and resulted in hospitalization. The overall case fatality rate was 0.4%. Respiratory disturbance occurred in 46 cases (5.1%). Patients with respiratory complications tended to be younger (53.4+13.9 vs 60.3+12.7 years old; p=0.002) and with higher frequency of allergy history (26.1% vs 14.7%; p=0.032) compared to those without respiratory complications. Based on multivariate logistic regression, the adjusted OR for history of allergy was 2.23 (95%CI: 1.04 - 4.78, p = 0.041). CONCLUSIONS: RASBA in Thai population occurred mostly in elderly female patients and often led to hospitalization. Since large number of patients is regularly exposed to RAS-blockers, a nationwide attempt to raise awareness of clinicians when prescribing RAS-blockers is prudent.
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Win et al. (2015) conducted an observational in RAS blockers-associated angioedema (n=895). RAS blockers was evaluated on Respiratory complications (association with history of allergy) (OR 2.23, 95% CI 1.04 - 4.78, p=0.041). In Thai patients with RAS blocker-associated angioedema, respiratory complications occurred in 5.1% of cases and were significantly associated with a history of allergy (adjusted OR 2.23; p=0.041).
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