Monoclonal antibodies in the management of hereditary angioedema

Hereditary angioedema (HAE) is a rare, potentially life-threatening, unpredictable disease characterized by recurrent subcutaneous and/or submucosal edema (HAE attacks). HAE imposes a significant biopsychosocial burden on patients and their families owing to the erratic nature and variable severity of HAE attacks. Current guidelines appoint sustained disease control as one of the main treatment goals, achievable through the initiation of long-term prophylaxis (LTP).

This review focuses on the evaluation of three monoclonal antibodies developed for LTP of HAE, namely lanadelumab (Takhzyro®), garadacimab (Andembry®), and navenibart, in this order. Lanadelumab inhibits plasma kallikrein and has been an approved LTP option since 2018. Garadacimab inhibits activated factor XII (FXIIa) and has been approved for LTP in 2025. Navenibart, a drug currently under development, inhibits plasma kallikrein and has been modified to extend its circulating half-life.

The transition from older non-targeted LTP options to the use of monoclonal antibody-based therapies has fundamentally changed the treatment landscape by offering a safe, effective, and highly targeted solution. Although having different pharmacological characteristics, these LTP options share the same objective: to achieve complete disease control.