How Does Long-Term Attenuated Androgen Prophylaxis Affect Neoplasms, CVD Risk?

Data indicated that hypertension was more common in patients on LTP-AA of over 10 years
Data indicated that hypertension was more common in patients on LTP-AA of over 10 years

ATLANTA, GA—Patients with hereditary angioedema (HAE) on long-term prophylaxis with attenuated androgen (LTP-AA) appeared to have a similar risk for cardiovascular diseases and events but a lower number of neoplasms compared to untreated patients, according to a study presented at the 2017 AAAAI Annual Meeting.

A team of researchers, led by Antonio Gidaro, from the Department of Biomedical and Clinical Sciences, University of Milan, Italy, aimed to investigate the prevalence of cardiovascular risk factors and events and malignancies in both Italian patients with C1-INH HAE as well as in patients who have received LTP-AA prophylactically.

The team utilized the ITACA database after adding patient characteristics obtained through a telephone interview using a standardized questionnaire given by a doctor. The study involved a total of 289 patients at least 18 years old that had a "diagnosis of C1-INH-HAE based on personal history and/or family history of angioedema, and functional or antigenic plasma levels of C1 INH <50% of normal.”

Of the total patients, 139 (48%) had never received long-term prophylaxis, while 150 (52%) had received prophylaxis. The study authors further analyzed patient groups by the type of therapy they had received as well as the duration of use of prophylactic therapy. 

Data indicated that hypertension was more common in patients on >10 years of LTP-AA (odds ratio [OR] 2.3, 95% CI: 1.1–4.2) and hypercholesterolemia in patients on >15 years of LTP-AA vs. patients without LTP (OR 2.4, 95% CI: 1.0–5.4). However, after using a statistic regression model to confirm their results, the authors found that this data was not statistically significant. 

The authors reported that cardio-cerebrovascular events were seen in 40 patients (13.8%) and that 25 patients (8.6%) experienced at least one event. The authors also reported that a similar prevalence of cardiovascular events was seen in patients who were not treated with AA (n=13, 51%) with those who had been treated with AA (n=12, 48%).

Further, the authors reported that "the prevalence of oncological diseases in patients not on prophylaxis (10.1%) is significantly higher than that of the Italian population." Additionally, for patients taking prophylaxis, the authors found that there was a lower prevalence of oncological diseases (2.2%) compared to the Italian population. The authors also reported that 7/17 tumors (41%) were found to be hormone-dependent. Of the 7 hormone-dependent tumors, 6 were in the population not taking prophylaxis while 1 was in the prophylaxis-taking population.

For patients with HAE, the prevalence of hypertension and hypercholesterolemia was found to be similar for patients receiving LTP-AA and those taking "on demand therapy". Additionally, the prevalence of cardiovascular events was also found to be similar for patients taking and not taking LTP-AA. The study authors also reported that “patients without prophylaxis have a higher prevalence of oncological diseases than patients in LTP-AA."