Two new developments in the prevention of hereditary angioedema attacks

Hereditary angioedema (HAE) is a rare and potentially life-threatening genetic condition that occurs in about one in 10,000 to one in 50,000 people. It involves unpredictable recurrent attacks of severe swelling (angioedema) in various parts of the body, including the hands, feet, genitals, stomach, face and/or throat. Airway swelling can restrict breathing and be fatal.1 Episodes of HAE may be triggered by physical trauma, emotional stress, surgery, menstruation, pregnancy, angiotensin-converting enzyme inhibitors and other factors, but often occur without a known trigger. Symptoms usually begin early in life, commonly by age 13, and may increase in severity after puberty.1An untreated HAE attack often lasts for three days, sometimes longer. Many people with HAE have three or more attacks per month. The frequency and severity of attacks vary significantly among individuals.1Most people with HAE have a genetic defect that causes a deficiency in the plasma protein, C1-inhibitor. Others may have normal levels of C1-inhibitor, with genetic defects in other genes causing their angioedema.1The following information highlights two recent developments in the prevention of HAE attacks in Canada. First, CSL Behring is introducing Andembry (garadacimab solution for subcutaneous [SC] injection) for routine prevention of attacks of HAE in adults and children 12 years of age or older. The product is not indicated for acute treatment of HAE attacks.2Garadacimab is a monoclonal antibody inhibitor of activated Factor XII (FXIIa). Inhibition of FXIIa prevents the activation of prekallikrein to kallikrein and the generation of bradykinin (which is associated with inflammation and swelling in HAE attacks), thereby potentially reducing the cascade of events leading to an HAE attack.2Andembry is supplied in a 200 mg/1.2 mL single-dose prefilled pen. An initial loading dose of 400 mg is recommended, administered as two 200 mg SC injections on the first day of treatment, followed by a monthly dose of 200 mg SC. The abdomen, thighs and upper outer arms are the recommended SC injection sites. The product may be self-administered or administered by a caregiver after proper training on SC injection technique.2 The most common adverse effects of garadacimab are erythema, bruising, pruritus and urticaria at the injection site, as well as headache and abdominal pain. The product carries a theoretical risk of severe hypersensitivity reactions, but the product monograph reports none have been observed.2No drug interaction studies have been conducted with garadacimab. It has only been studied as a monotherapy, not in combination with other products indicated for long-term prophylaxis of HAE. Very limited clinical data are available on the use of concomitant antiplatelet/anticoagulant medication. Garadacimab can prolong activated partial thromboplastin time (aPTT) due to an interaction with the aPTT assay.2Andembry prefilled pens should be stored in a refrigerator (2⁰C–8⁰C) and kept in the outer carton to protect from light. Pens may be stored at room temperature (up to 25°C) for up to two months, but not beyond the expiry date.2 The second new development in HAE attack prevention is the expansion of the age range for use of Takeda’s Takhzyro (lanadelumab solution for SC injection). It is now indicated for the routine prevention of attacks of HAE in adults and children two years of age or older. It was formerly indicated for this use only in adults and adolescents 12 years of age or older.3The recommended dosage of Takhzyro for children two years up to 12 years of age is based on body weight. Children weighing 10 kg to < 20 kg should be started on 150 mg SC every four weeks. An increase to 150 mg every three weeks may be considered in patients with insufficient control of attacks. Children two to < 12 years of age who weigh 20 kg or more should be started on 150 mg SC every two weeks. A dose of 150 mg every four weeks may be considered in patients who are stable and attack-free on treatment.3 In addition to the expanded age range, Takhzyro (lanadelumab 150 mg/mL) is now supplied in a new format. A 2 mL prefilled pen joins the existing 2 mL prefilled syringe and 2 mL vial. Note that the new Takhzyro prefilled pen has not been studied in children two to < 12 years of age and should not be used in this age group.3To administer Takhzyro to children two to < 12 years of age, the prefilled syringe or single-use vial should be removed from the refrigerator about 15 minutes before injection to allow the solution to come to room temperature. A healthcare professional or trained caregiver should inject the drug SC into the child’s abdomen, thigh or upper arm.3 Hereditary Angioedema (HAE) Canada is an excellent source for patient information about HAE. In addition to providing information about the condition, the website summarizes acute and preventive treatments, as well as clinical trials being conducted in Canada.1 ReferencesHereditary Angioedema (HAE) Canada. Health Canada approved treatments. (accessed March 26, 2026).CSL Behring Canada Inc. Andembry (garadacimab injection) product monograph. Ottawa, ON: August 6, 2025. (accessed March 26, 2026).Takeda Canada Inc. Takhzyro (lanadelumab injection) product monograph. Toronto ON; March 2, 2026. (accessed March 26, 2026).

Two new developments in the prevention of hereditary angioedema attacks

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