Alpha-1 Antitrypsin Deficiency

The clinical effects of alpha-1 antitrypsin deficiency (AATD) are highly variable and are dependent on genotype, phenotype and exposure to risk factors such as smoking and pollution.1,2

AATD is a genetic condition associated with low protein levels of functional alpha-1 proteinase inhibitor (A1PI).2,3

The main clinical manifestations involve the lungs, leading to emphysema, and the liver, but it can also be associated with other skin and cardiovascular disorders.3,4,5

Pathophysiology

AATD is caused by a mutation in the SERPINA1 gene on chromosome 14 encoding for A1PI.6 Each person has two alleles (variants) of the gene, one inherited from each parent where the most common ones are:5

  • M allele— results in normal levels of functional A1PI6,7
  • S allele—  expresses approximately 50 to 60% normal A1PI where the variant is unstable and easily degrades8,9
  • Z allele—  expresses approximately 10 to 20% of normal A1PI due to much of the A1PI accumulating in the liver8,9


A1PI is primarily synthesized in the liver and secreted into the bloodstream where it diffuses into the lungs and other tissues.2,8,10  The main role of A1PI is to inhibit neutrophil elastase (NE) and keep its activity in check.2,10 NE is a proteinase responsible for the breakdown of a variety of proteins involved in modulating inflammation and therefore plays a key role in tissue repair and protection from infections.11 Therefore, a deficiency in functional A1PI results in excessive NE activity and leads to the degradation of lung tissue and blood vessels.12

Epidemiology

The prevalence of AATD varies by genotype with an estimated 3.4 million people living with the disease worldwide (protease inhibitor [Pi] SS, PiSZ, PiZZ) and 116 million carriers (PiMS, PiMZ).2,13 In the U.S., it’s estimated that more than 500,000 people have deficient PiSS and PiSZ allele combinations, and 60,000 have the PiZZ genotype which is associated with severe deficiency, while more than 24 million people are carriers (PiMS, PiMZ).8

Diagnosis

Variability in clinical presentations results in delayed and misdiagnosis, which means the majority of cases remain undiagnosed (>90%).1,14,15,16 A confirmed AATD diagnosis should involve both quantitative and qualitative laboratory determinations:10,17,18,19

  • Quantitative determination of serum A1PI levels
  • Confirmatory qualitative assessment of genotyping/phenotyping
  • DNA sequencing may be necessary to identify rarer mutations

Navigating AATD

The primary manifestations of AATD are lung disease and liver involvement, which are irreversible and progressive.20 Therefore, the consequences of delayed or misdiagnosis can be fatal in those patients with severe AATD; most commonly due to respiratory failure (58% of deaths), including pneumonia and pneumothorax; and liver diseases (12% of deaths), including liver failure and primary carcinoma.21 This leads to a high disease burden, associated with increased mortality, morbidity, quality of life impairment and cost.21,22,23,24,25,26 Nonpharmacological approaches are crucial to managing AATD and include smoking cessation, maintaining a healthy diet and moderate exercise, staying up to date with recommended immunization and pulmonary rehabilitation.17 Currently, augmentation therapy is the only A1P1 pharmacological option available and can be part of the strategy in the management of patients with AATD-related emphysema.10,27,28 It is administered by intravenous infusion and aims to increase serum A1PI levels.2 However, the manufacturing process is complex and expensive to produce as it needs to be purified from large volumes of human plasma.29

Medication Resources

Aralast® NP

[Alpha1-Proteinase Inhibitor (Human)]

Upcoming & Past Conferences in Allergy & Immunology

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Clinical Immunology Society (CIS), 2024

May 1 - 4, 2024 | Link to Event

Annual meeting with the goal of providing a stimulating forum with presentations and discussions on the latest advances in clinical immunology, including primary immunodeficiencies and immune dysregulatory diseases.

Professional Society for Health Economics and Outcomes Research (ISPOR), 2024

May 5 - 8, 2024 | Link to Event

Leading global conference discussing how to establish, incentivize, and share value sustainable for health systems, patients, and technology developers.

American Thoracic Society (ATS), 2024

May 17 - 22, 2024 | Link to Event

International conference showcasing the latest advances in pulmonary disease, critical illness, and sleep disorders for scientists and clinicians at all stages of their careers.

Eastern Allergy Conference (EAC), 2024

May 30 - June 2, 2024 | Link to Event

Regional annual conference discussing the most current information from top experts in allergy, asthma, and immunology.

European Academy of Allergy & Clinical Immunology (EAACI), 2024

May 31 - June 3, 2024 | Link to Event

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Peripheral Nerve Society (PNS), 2024

June 22 - 25, 2024 | Link to Event

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American Association of Nurse Practitioners (AANP), 2024

June 25 - 30, 2024 | Link to Event

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Academy of Managed Care Pharmacy (AMCP), 2024

April 15 - 18, 2024

Large assembly of pharmacy and healthcare professionals dedicated to the issues of managed care pharmacy, offering immersive education sessions and keynote presentations.

American Academy of Neurology (AAN), 2024

April 13 - 18, 2024

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National Home Infusion Association (NHIA), 2024

March 23 - 27, 2024

Annual conference ideal for infusion professionals or those seeking opportunities in the industry to come together and explore the latest trends in offering home-based services.

Hereditary Angioedema International (HAEi), 2024

March 15 - 17, 2024

Every second year HAEi gathers HAE patients, caregivers, healthcare professionals, and industry representatives with a sole focus of sharing experience and knowledge on HAE topics.

Annual Meeting American Academy of Allergy Asthma and Immunology (AAAAI), 2024

February 23 - 26, 2024

Premier global educational event for allergists and immunologists, with thousands of attendees each year, discussing allergies, asthma, and immune deficiency disorders.

  • Patient-Reported Outcomes Among Patients With Hereditary Angioedema Within Underrepresented Racial or Ethnic Groups

Takhzyro® (lanadelumab-flyo)

  • Real-World Treatment Outcomes in Patients With Hereditary Angioedema Receiving Lanadelumab or Other Long-Term Prophylaxis
  • Understanding the Impact of Long-Term Prophylaxis Switches for Patients With Hereditary Angioedema

Western Society of Allergy, Asthma and Immunology (WSAAI), 2024

February 4 - 8, 2024

Annual scientific session uniting allergists, immunologists, nurses, and physician assistants aimed at maintaining the highest standard of practice in allergy care.

  • Understanding Social Determinants of Health and Outcomes in Patients With Hereditary Angioedema in the United States
  • Quality of Life Among Patients With Hereditary Angioedema Within Underrepresented Racial or Ethnic Groups

Takhzyro® (lanadelumab-flyo)

  • Real-World Quality of Life in Patients With HAE Receiving Lanadelumab or Other Long-Term Prophylaxis

American College of Allergy, Asthma & Immunology (ACAAI), 2023

November 9 - 13, 2023

Global meeting featuring thought leaders from around the world focused on advancing patient care in allergy and immunology.

  • Healthcare Experiences Prior to Hereditary Angioedema Diagnosis in Underrepresented Racial/Ethnic Groups in the United States
  • Perspectives of Medical Care Among Patients With Hereditary Angioedema Within Underrepresented Racial or Ethnic Groups

Takhzyro® (lanadelumab-flyo)

  • Real-World Outcomes in Patients With HAE Receiving Lanadelumab Long-Term Prophylaxis for 3 Years or Longer
  • Real-World Quality of Life in Patients With HAE Receiving Lanadelumab or Other Long-Term Prophylaxis

Academy of Managed Care Pharmacy Nexus (AMCP Nexus), 2023

October 16 - 19, 2023

Annual event with more than 2,500 members and non-members of the AMCP to engage on the latest innovations and most intentional networking in managed care pharmacy.

  • Healthcare Resource Use Among Individuals With Chronic Obstructive Pulmonary Disease With and Without Alpha-1 Antitrypsin Deficiency in a United States Medicare Advantage Population
  • Characteristics, Healthcare Resource Utilization, and Costs Among Patients With Multifocal Motor Neuropathy: a United States Claims Database Cohort Study

Takhzyro® (lanadelumab-flyo)

  • A Cost Model Comparing Long-Term Prophylaxis Options for Hereditary Angioedema: Lanadelumab and Berotralstat
  • Characteristics of Patients With Hereditary Angioedema on Long-Term Prophylaxis With Lanadelumab Who Did and Did Not Down-Titrate Lanadelumab During 18 Months of Treatment Persistence

ID Week, 2023

October 11 - 15, 2023

The joint annual meeting of leading global societies dedicated to infectious disease research and advances.

American College of Chest Physicians (CHEST), 2023

October 8 - 11, 2023

Annual meeting offering the most up-to-date education in pulmonary, sleep, and critical care medicine through simulation sessions and original research presentations with clinical relevance to practitioners.

Immunoglobulin National Society (IgNS), 2023

October 5 - 8, 2023

National conference of IgNS bringing together professionals and practitioners from all disciplines and clinical specialties to advance Ig therapy practice, while providing networking and comprehensive education opportunities.

Aspen Allergy Conference (AAC), 2023

July 30 - August 3, 2023

Annual conference that invites state-of-the-art speakers from around the world to discuss basic science and clinical topics on allergy, asthma, and immunology.

European Academy of Allergy & Clinical Immunology (EAACI), 2023

June 9 - 11, 2023

The flagship meeting of the EAACI and the world’s largest congress specializing in the field of allergy and clinical immunology.

Takhzyro® (lanadelumab-flyo)

  • Clinical Outcomes and Quality of Life in Patients With HAE Receiving Lanadelumab Long-Term Prophylaxis: Interim Analysis of 3-Year Real-World Data

American Society of Clinical Oncology (ASCO), 2023

June 2 - 6, 2023

Annual meeting providing a forum for oncology professionals, patient advocates, and industry representatives to learn about and discuss the important issues in cancer care across a variety of disease sites, treatment approaches, and disciplines.

Eastern Allergy Conference (EAC), 2023

June 1 - 4, 2023

Regional annual conference discussing the most current information from top experts in allergy, asthma, and immunology.

American Thoracic Society (ATS), 2023

May 19 - 24, 2023

International conference showcasing the latest advances in pulmonary disease, critical illness, and sleep disorders for scientists and clinicians at all stages of their careers.

  • Machine-learning Model Identifies Patients With Alpha-1 Antitrypsin Deficiency (AATD): Expert Validation and Comparison of Journeys For Patients With AATD Versus Chronic Obstructive Pulmonary Disease
  • Machine-learning Model Identifies Patients With High Probability of Alpha-1 Antitrypsin Deficiency Across the United States
  • Survey of Diagnostic Journey, Treatment Experience, and Impact on Daily Living of Patients with Alpha-1 Antitrypsin Deficiency

Clinical Immunology Society (CIS), 2023

May 18 - 21, 2023

Annual meeting with the goal of providing a stimulating forum with presentations and discussions on the latest advances in clinical immunology, including primary immunodeficiencies and immune dysregulatory diseases.

  • Patterns of IgG Testing and Rates of Hypogammaglobulinemia in Patients With Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

Professional Society for Health Economics and Outcomes Research (ISPOR), 2023

May 7 - 10, 2023

Leading global conference discussing how to establish, incentivize, and share value sustainable for health systems, patients, and technology developers.

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AATD Mechanism of Disease

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