Key result
Discontinuation of ACE inhibitors resulted in further recurrences of angioedema in 46% of patients, with 16% experiencing an unchanged frequency of attacks.
Why the study?
Does discontinuation of ACE inhibitors prevent recurrence of angioedema in patients who developed it during treatment?
Observational (n=111)
No
Does discontinuation of ACE inhibitors prevent recurrence of angioedema in patients who developed it during treatment?
Nearly half of patients with ACE-I-related angioedema continue to experience recurrences after drug discontinuation, suggesting an underlying predisposition rather than a purely drug-induced phenomenon.
ACE inhibitor discontinuation may not eliminate angioedema recurrences; leaves open underlying predisposition and requires prospective confirmation.
OBJECTIVE: To investigate, for the first time, the frequency of recurrences of angiotensin-converting enzyme inhibitor (ACE-I)-related angioedema after the discontinuation of ACE-I. METHODS: This retrospective study was conducted in an outpatient tertiary-level centre for a total period of 173 months (about 14 years). Consecutive patients with recurrent angioedema symptoms, initiated during treatment with an ACE-I, who had been followed for at least 12 months after discontinuation of the drug were eligible. The primary study variable was the incidence of recurrences of angioedema after ACE-I discontinuation. Angioedema location, type of ACE-I and indication for this treatment and the drugs prescribed after the discontinuation of ACE-I were also evaluated. RESULTS: In total, 111 patients were followed; 54 of them (49%) were on enalapril. After discontinuation from ACE-I, 51 patients (46%) had further recurrences of angioedema; in 18 relapsers (16% of the total), the frequency of angioedema recurrences remained unchanged when compared with that reported during ACE-I treatment. The large majority of relapsers (88%) had the first recurrence of angioedema within the first month since ACE-I discontinuation. The switch to a different antihypertensive therapy did not seem associated with a reduction in the frequency of angioedema attacks. CONCLUSION: Even with all the limitations on any observational analysis, this long-term study suggests for the first time that patients with angioedema started while on ACE-I treatment seem to have a condition predisposing to angioedema that is elicited by the treatment with these drugs. Further studies in this field appear advocated due to the potential severity of angioedema attacks.
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Beltrami et al. (2011) conducted an observational in angiotensin-converting enzyme inhibitor-related angioedema (n=111). Discontinuation of ACE-I was evaluated on incidence of recurrences of angioedema after ACE-I discontinuation. Discontinuation of ACE inhibitors resulted in further recurrences of angioedema in 46% of patients, with 16% experiencing an unchanged frequency of attacks.
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