Conestat

Conestat, or conestat alfa, is a recombinant human C1 esterase inhibitor used to treat acute attacks of hereditary angioedema (HAE) in patients with C1-INH deficiency. It is produced in transgenic rabbits that secrete the human C1 esterase inhibitor, making it distinct from plasma-derived C1-INH products.

Mechanism and use: Conestat replenishes deficient C1 esterase inhibitor activity, thereby inhibiting the kallikrein-kinin system and reducing bradykinin formation. This helps to decrease vascular permeability and swelling during an HAE attack. It is indicated for the treatment of acute HAE attacks in adults and in many markets for adolescents as well, to provide rapid relief of symptoms.

Administration and dosing: Conestat is given by intravenous injection. A typical dose is 50 units per kilogram of body weight, up to a maximum per-injection dose specified by labeling. Treatment is most effective when administered at the onset of an attack, with patients often experiencing relief within an hour.

Regulatory status and availability: Conestat alfa is marketed under brand names such as Ruconest in several regions. It has been approved in the European Union and the United States (FDA) for acute HAE attacks, reflecting its role as a targeted therapy for C1-INH deficiency–related angioedema.

Safety and considerations: Common adverse effects include headache, nausea, and injection-related reactions. Hypersensitivity and rare anaphylactic reactions can occur. As with any biologic therapy, clinicians assess for known allergies to the product or its components. It is contraindicated in individuals with hypersensitivity to conestat alfa or its excipients.