Aygören-Pürsün et al. Allergy, Asthma & Clinical Immunology 2010, 6:21 http://www.aacijournal.com/content/6/1/21 Page 3 of 4 Table 1 Pharmacokinetics of pasteurized pd C1-INH Concentrate (median values) Children on Demand n = 6 Adults on Demand n = 19 Adults IRT n = 15 Incremental IVR [%rise/U/kg bw] 2.2 2.0 2.9* Tmax [hr] 0.6 1.0 0.5 T 1/2 [hr] 32.9 39.1 30.9** MRT [hr] 47.5 56.5 44.6** AUC [U*hr/mL] 13.4 16.7 15.7 Clearance [mL/kg*hr] 1.1 0.9 1.0 Vss [mL/kg] 50.0 56.5 37.5*** *p = 0.006, ** p = 0.052, *** p = 0.004, statistically significant differences of Adults IRT vs. Adults on demand IVR = in vivo recovery Tmax = Median time to maximum functional pd C1-INH level T1/2 = Terminal elimination half-life MRT = Mean residence time AUC = area under the curve Vss = Volume of distribution at steady state pediatric patients, parents are the care-givers for home therapy. With pasteurized pd C1-INH home therapy, a rapid response to treatment is observed. There were no reports of treatment- related adverse events or life- threatening events. The experience with Icatibant in Frankfurt is very lim- ited at the moment. 1% of the total patient population at the Frankfurt HAE center has been treated with Icati- bant within studies or in a routine setting. Due to its pathophysiologic mechanism, which is different from C1-INH, Icatibant is a valuable treatment option in two of our patients in whom pasteurized pd C1-INH con- centrate cannot be applied: one patient with a known allergy to pd C1-INH concentrate and one patient with acquired angioedema non-responsive to pd C1-INH concentrate due to high anti-C1-INH antibody titers. In the therapy of a life-long condition, pharmacoeconomic considerations may also be of relevance. Based on the current prices in Germany, the cost of on demand treat- ment of an acute attack with one dose of Icatibant (30 mg) is equal to the cost of one dose of 20 U/kg body weight (bw) of pasteurized pd C1-INH concentrate for a 70 kg standard patient. For a 100 kg patient receiv- ing a dose of 20 U/kg bw therapy with pasteurized pd C1-INH concentrate, is more expensive compared to Icatibant. However, in all other settings, e.g. in 50 kg-, 70 kg- or 100 kg - patients treated with a dose of 10 U/kg pd C1- INH concentrate, or even in a 50 kg- patient treated with 20 U/kg pd C1-INH concentrate, treatment with a single dose of Icatibant is more expensive compared to pd C1-INH concentrate. This is important in view of the fact that in contrast to the results of the IMPACT-1 study [6] the necessity for a dose of 20 U/kg of pd C1- INH concentrate is rare in clinical practice. In the vast majority of cases, 500 - 1000 U pasteurized pd C1-INH concentrate, usually corresponding to ≤ 10 U/kg to < 20 U/kg, are effective for treatment of acute attacks, parti- cularly when treatment is initiated rapidly [3-6]. Furthermore, follow-up doses of pd C1-INH concentrate can be administered in fractions of 500 U, which is sig- nificantly more economical compared to follow-up injections of Icatibant that may be commonly required [11]. In conclusion, the individualized therapeutic strategies provided by our HAE center aim to limit the constraints in daily life that occur for many HAE patients. Furthermore, we seek to optimize the economic bur- den of the disease while offering a maximum quality of life to our patients. List of Abbreviations AAE: acquired angioedema; bw: body weight; C1-INH: C1-esterase-inhibitor; HAE: hereditary angioedema; IRT: individual replacement therapy; pd: plasma derived Acknowledgements We are grateful for the excellent support provided by the nursing staff at our clinical unit, especially Karin Andritschke und Birgit Luft, and by our technicians Hildegard Stoll, Ruth Biller, and Sylvia Figura, who analyzed plasma C1-INH levels and other laboratory parameters. In addition, our efforts benefited from the continuous support received over the years from our assistants Sigrun Preisser and Katharina Brassat. Financial support: CSL Behring GmbH, Hattersheim, Germany Authors’ contributions All authors contributed equally to this manuscript and have read and approved the final version of this manuscript. Competing interests This study was supported by an unrestricted grant from CSL Behring GmbH, Hattersheim, Germany. CSL Behring GmbH had no influence on the collection, analysis, or interpretation of data, and had no influence on the decision to submit this manuscript for publication. The authors certify that they have no affiliation with or financial involvement in any organization or entity with direct financial interest in the subject matter or materials discussed in this manuscript (e.g., employment, consultancies, board membership, stock ownership). Any research or project support is identified in the manuscript. The corresponding author receives support for participation of scientific conferences from CSL Behring, Shire and Viropharma. Received: 2 June 2010 Accepted: 28 July 2010 Published: 28 July 2010 References 1. Bowen T, Cicardi M, Bork K, Zuraw B, Frank M, Ritchie B, Farkas H, Varga L, Zingale LC, Binkley K, Wagner E, Adomaitis P, Brosz K, Burnham J, Warrington R, Kalicinsky C, Mace S, McCusker C, Schellenberg R, Celeste L, Hebert J, Valentine K, Poon MC, Serushago B, Neurath D, Yang W,