title: Current medical management of hereditary angioedema: follow-up survey of US physicians.
abstract: BACKGROUND
  A physician survey conducted in the United States between October 2009 and February 2010 revealed wide variability in hereditary angioedema (HAE) management.
  
  
  OBJECTIVE
  A follow-up survey was conducted to assess the impact of newly available treatment options and investigate changes in HAE care patterns.
  
  
  METHODS
  Between March and June 2013, 6570 physicians were contacted, of whom, 245 HAE-treating physicians responded. Participants completed a 46-question online survey that was closely patterned after the initial survey. Although most data were analyzed descriptively, selected questions underwent statistical analysis to evaluate differences in treatment patterns between the 2 surveys.
  
  
  RESULTS
  Compared with the prior survey, this follow-up survey found that the proportion of physicians who reported danazol as the preferred long-term prophylaxis agent declined from 56% to 23% (P < .00005); conversely, C1-esterase inhibitor increased in this category (20% to 57%; P < .00005). The percentage of attacks self-treated at home increased from 8% to 27% (P < .00005). Decreases were observed in emergency department visits (61% to 54%; P = not significant) and hospitalizations (13% to 3%; P = .0001) for HAE attacks. The percentage of patients perceived by physicians to be very satisfied with HAE treatment increased from 13% to 40% (P < .00005). In 2013, convenience was reported more frequently as an important patient factor that drove long-term prophylaxis choice (27% vs 10%; P < .00005), whereas adverse effects were cited less frequently (16% vs 42%; P < .00005); in both surveys, cost and/or insurance coverage was the greatest driver in this category (43% and 46%).
  
  
  CONCLUSIONS
  Analysis of these findings suggests that the change in HAE treatment has increased self-treatment at home, decreased emergency department visits and/or hospitalizations, and provided greater patient satisfaction.
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of California, San Diego, La Jolla, Calif. Electronic address: mriedl@ucsd.edu.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Riedl
authors.affiliation: Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.affiliation: Marycliff Allergy Specialists, Spokane, Wash.
authors.forename: Richard
authors.initials: R
authors.lastname: Gower
mesh_terms: D054179:Angioedemas, Hereditary / Q000175:diagnosis / Q000188:drug therapy*; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017060:Patient Satisfaction; D010820:Physicians; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D050718:Complement C1 Inhibitor Protein; D003613:Danazol
keywords: Antifibrinolytics; C1-INH; Danazol; Hereditary angioedema; Home treatment; Icatibant; Long-term prophylaxis; On-demand therapy; Self-administration; Short-term prophylaxis; ecallantide