OVERVIEW
This free activity, entitled “Advances in Hereditary Angioedema: Prompt Intervention to Reduce Disease Burden,” consists of three presentations and panel discussions, a Learning Assessment, and an Evaluation form. The content of this virtual lecture is derived from a symposium presented on May 16, 2009, in Chicago, Illinois.

MEDIA: Virtual Lecture or Podcast
INTERNET RELEASE DATE: July 6, 2009
(Continuing education credit is no longer available for this activity.)

Estimated time to complete this activity: 1.75 hours

TARGET AUDIENCE
This activity has been designed to meet the educational needs of physicians involved in the care of patients with hereditary angioedema.

ACTIVITY PURPOSE
This activity is intended to assist physicians in understanding how to manage patients with hereditary angioedema.

STATEMENT OF NEED
Hereditary angioedema (HAE) is an autosomal dominant disease caused by a functional or quantitative defect in C1 inhibitor. In the United States, HAE is estimated to afflict 10,000 people.1 C1 inhibitor is a member of the serpin family of serine protease inhibitors and is the major inhibitor of several complement proteases and contact-system proteases.2 During HAE attacks, these signaling cascades are set in motion, resulting in the production of several vasoactive substances, including bradykinin.

Patients with HAE suffer from recurrent attacks of intense localized edema involving the skin, airway and visceral organs. Left untreated, most patients will suffer at least one acute attack per month, resulting in debilitation for 20 to 100 days per year.3 Chronic therapy with attenuated androgens or plasmin inhibitors has been the mainstay of therapy; however, many new therapies for prophylaxis or acute treatment are on the horizon. Clinical trials are ongoing with a C1 inhibitor purified from plasma, a recombinant C1 inhibitor, a kallikrein inhibitor, and a bradykinin type 2 receptor antagonist. In October 2008, the US Food and Drug Administration approved a highly purified, nanofiltered plasma-derived C1 inhibitor (human) for routine prophylaxis against HAE attacks in adults and adolescents. The future of HAE treatments appears promising—offering hope to thousands who suffer from this debilitating disease.

1Frank MM. Urticaria and angioedema. In: Goldman L, Bennett JC, eds. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA:
  WB Saunders Co; 2000:1440-1445.
2Zuraw BL. Hereditary angioedema. N Engl J Med. 2008;359:1027-1036.
3Cicardi M, Agostini A. Hereditary angioedema. N Engl J Med. 1996;334:1666-1667.

EDUCATIONAL OBJECTIVES
After completing this activity, the participant should be better able to:

• Describe the pathophysiology and immunologic features of hereditary angioedema (HAE)
• Review the signs and symptoms of patients who present with HAE
• Identify diagnostic considerations in HAE
• Outline therapeutic strategies for prophylaxis and acute HAE attacks

METHOD OF PARTICIPATION
There are no fees for participating and receiving CME credit for this activity. During the period July 06, 2009, through July 06, 2010, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the Learning Assessment by recording the best answer to each question in the "Learning Assessment Answers" box on the Evaluation form; 4) complete the Evaluation form; and 5) mail or fax the Evaluation form with the Learning Assessment answers to Postgraduate Institute for Medicine. You may also complete the Learning Assessment online at www.cmeuniversity.com. Click on “Find Post-Test/Evaluation by Course” on the navigation menu, and search by Project ID 6297.

Participants must receive a score of at least 70% on the Learning Assessment and must complete and submit the Evaluation form to successfully complete this activity. Participants who successfully complete the Learning Assessment and Evaluation form via www.cmeuniversity.com will have a statement of credit made available immediately. Participants who successfully complete this activity and submit the Learning Assessment and Evaluation form via fax or mail will be issued a statement of credit via US mail in 4 to 6 weeks.

PHYSICIAN CONTINUING EDUCATION
ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Robert Michael Educational Institute LLC (RMEI). PIM is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT DESIGNATION
Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FACULTY
Michael M. Frank, MD (Chair)
Samuel L. Katz Professor of Pediatrics, Medicine, and Immunology
Duke University School of Medicine
Durham, North Carolina

Timothy J. Craig, DO
Professor of Medicine and Pediatrics
Training Program Director
Section Chief of Allergy, Asthma, and Immunology
Director of Clinical Respiratory and Allergy Research
Departments of Medicine and Pediatrics
Section of Allergy, Asthma, and Immunology
Pennsylvania State University College of Medicine
Hershey, Pennsylvania

Aleena Banerji, MD
Assistant Training Program Director
Allergy and Immunology
Assistant in Medicine
Massachusetts General Hospital
Boston, Massachusetts

DISCLOSURE OF CONFLICTS OF INTEREST
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

• Dr. Michael M Frank has an affiliation with ViroPharma Incorporated and CSL Behring (Consultant and Research Grant Support); Dyax Corp., Shire Deutchland, and Pharming Group NV (Consultant); and Dyax Corp. (Chair, Data Safety Monitoring Board).
• Dr. Timothy J. Craig has an affiliation with ViroPharma Incorporated, Dyax Corp., Pharming Group NV, Jerini AG, and CSL Behring (Consultant and Research).
• Dr. Aleena Banerji has an affiliation with ViroPharma Incorporated, Dyax Corp., and Shire (Consultant); and ViroPharma Incorporated (Research).

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Postgraduate Institute for Medicine

• Linda Graham, RN, BSN, has no affiliations with commercial interests to disclose.
• Jan Hixon, RN, BSN, MA, has no affiliations with commercial interests to disclose.
• Trace Hutchison, PharmD, has no affiliations with commercial interests to disclose.
• Julia Kirkwood, RN, BSN, has no affiliation with commercial interests to disclose.
• Jan Schultz, RN, MSN, CCMEP, has no affiliations with commercial interests to disclose.
  

Robert Michael Educational Institute LLC

• Sherri Kramer, MD, has no affiliations with commercial interests to disclose.
• Laura Altobelli, MS, has no affiliations with commercial interests to disclose.

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. PIM, Robert Michael Educational Institute LLC (RMEI) and ViroPharma Incorporated do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, RMEI, or ViroPharma Incorporated. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings.

DISCLAIMER
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information and comparison with recommendations of other authorities.

FEE INFORMATION
There is no fee for this educational activity.

QUESTIONS & TECHNICAL ASSISTANCE
For questions regarding the content of this activity, contact the accredited provider for this CME activity: jjones@pimed.com. For technical assistance, contact jungsen@rmcom.net.

SYSTEM REQUIREMENTS
Hardware/Software requirements include:
• Windows 95, 98se, ME, XP, NT 4.0, 2000   
  - Internet Explorer 4.0+
  - Netscape Navigator 6.2+
  - AOL 8
  - Mozilla Firefox 1.0+
• Macintosh 9.2, OS X 10.1+
  - Safari 1.1+
  - Netscape Navigator 6.2+
  - Internet Explorer 5.2+
  - Mozilla Firefox 1.0+
• Additional Requirements
  - Macromedia Flash Player 7
  - Internal/external speakers
  - Broadband connection (DSL/cable) recommended

FOR MORE INFORMATION:

Additional educational activities offered by Robert Michael Educational Institute LLC can be found at www.RMEI.com or by calling toll-free to 866-770-RMEI.

United States Hereditary Angioedema Association
This non-profit patient advocacy organization is dedicated to expediting US approval of safer and more effective HAE therapies. In addition, the HAEA provides a wide range of services that include clinical trial placement, physician referrals, education, and individualized patient case management.
For more information, visit www.haea.org.

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