Prophylaxis in hereditary angioedema: a United Kingdom Delphi consensus

Hereditary angioedema (HAE) is a rare inherited disorder causing recurrent episodes of swelling that can be potentially life threatening. Treatment of HAE can be divided into on-demand treatment for swelling, and prophylaxis. The last UK consensus on HAE was in 2014 and since then, new medications for prophylaxis have been developed, with more drugs in the pipeline. International guidelines currently recommend the use of long-term prophylaxis (LTP) as the only way of achieving disease control and normalizing patient lives. Modern prophylactic medications are available in the UK, although access is restricted primarily by HAE attack frequency. To establish an updated view of UK clinicians and patients, a Delphi process was used to develop statements regarding LTP as well as other aspects of HAE management. There was consensus that UK access criteria for modern LTP agents based on numerical frequency of attacks alone are too simplistic and potentially disadvantage a cohort of patients who may benefit from LTP. Additionally, there was agreement that patients should be seen in expert centres, remote monitoring of patients is popular post-pandemic, and that the use of patient-reported outcome measures has the potential to improve patient care. Psychological health is an area in which patients may benefit, and recognition of this is important for future research and development. To establish an updated view of UK clinicians and patients, a Delphi process was used to develop statements regarding long-term prophylaxis and other aspects of hereditary angioedema management. UK access criteria for modern LTP agents based on numerical frequency of attacks alone were thought to be too simplistic, and potentially disadvantage a cohort of patients who may benefit from LTP. There was agreement that patients should be seen in expert centres, remote monitoring of patients is popular post-pandemic, patient-reported outcome measures has the potential to improve patient care, and psychological support may benefit patients.