Background: Hereditary angioedema (HAE) is associated with substantial health-related quality of life (HRQoL) impairments. Complete disease control and life normalization are key treatment goals. In previous studies, garadacimab prevented HAE attacks with a favorable safety profile and HRQoL improvements. Objective: HRQoL was evaluated in patients with HAE receiving garadacimab stratified by attack-free status. Methods: In the pivotal phase III study (NCT04656418), 39 patients received garadacimab 200 mg subcutaneously once monthly and 25 volume-matched placebo. In the phase III open-label extension (OLE), 90 patients in the garadacimab-naive group (received placebo in previous studies or newly enrolled) and 71 patients in the previous garadacimab exposure group (received garadacimab in previous studies) received garadacimab (NCT04739059). Patients ages ≥ 18 years completed the Angioedema Quality of Life (AE-QoL) questionnaire in both studies; scores were evaluated post hoc by attack-free status. Results: In the pivotal phase III and phase III OLE studies, 62% and 60% of patients, respectively, were attack-free. In the pivotal phase III study, the mean AE-QoL total score improved with garadacimab, from 38.8 (day 1) to 6.6 (month 6) for attack-free patients (n = 19) and to 18.4 for patients with one or more attacks (n = 14) versus a change in mean AE-QoL total score from 43.7 to 40.5 with placebo (n = 20). In the phase III OLE study, the mean AE-QoL total score for patients who were garadacimab naive decreased from 46.2 (day 1) to 8.6 (month 12) for attack-free patients (n = 34) and from 54.5 to 23.5 for patients with one or more attacks (n = 30). For the previous garadacimab exposure group, AE-QoL improvements were maintained from previous studies, regardless of attack-free status. Conclusion: Garadacimab was associated with HRQoL improvement versus run-in in all groups. After garadacimab exposure in previous studies, improvements were maintained in the phase III OLE study. Attack-free patients had the greatest HRQoL improvements, bringing them closer to complete disease control and life normalization.Clinical trials NCT04656418, NCT04739059, www.clinicaltrials.gov.

Allergy Asthma and Immunology Department of Medicine Pediatrics Obstetrics and Gynecology Maternal Fetal Medicine and Biomedical Sciences Pennsylvania State University Hershey Pennsylvania

CSL Behring AG Bern Switzerland

CSL Behring King of Prussia Pennsylvania

CSL Innovation GmbH Marburg Germany

Department for Children and Adolescents University Hospital Frankfurt Goethe University Frankfurt Frankfurt Germany

Department of Clinical Immunology and Allergology St Anne's University Hospital in Brno Brno Czech Republic

Department of Dermatology Saitama Medical Center Saitama Medical University Saitama Japan

Department of Internal Medicine and Hematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary

Division of Rheumatology and Clinical Immunology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong

From the Department of Dermatology and Allergy University Medical Center Mainz Johannes Gutenberg University Mainz Germany

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