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BEROTRALSTAT CAP,ORAL

Clinical Criteria Summary

Criteria for BEROTRALSTAT CAP,ORAL

Exclusion Criteria

  • Angioedema or abdominal pain not associated with C1 inhibitor deficiency, including hereditary angioedema with normal C1 inhibitor (HAE nC1-INH)
  • Concomitant use with another prophylaxis agent for HAE (e.g., donidalorsen, garadacimab, or lanadelumab)
  • Concomitant use with P-gp inducers
  • End-stage renal disease (CrCl < 15 mL/min or requiring hemodialysis)

Inclusion Criteria

  • Restricted to VA / VA Community Care allergy/immunology provider, dermatology provider, or locally designated expert
  • Diagnosis of Hereditary Angioedema Type 1 or 2 as established by laboratory testing
  • Long-term prophylaxis for HAE attacks or short-term prophylaxis prior to procedures or intubation

Laboratory & Diagnostic Requirements

  • Diagnostic laboratory results must include a C4 level below the limit of normal and one of the following: C1 inhibitor (C1-INH) antigenic level below the limit of normal or C1-INH functional level below the limit of normal
  • HAE with normal C1 inhibitor (HAE-nC1-INH) is caused by variants in genes such as FXII, PLG, KNG1, ANGPT1, MYOF, HS3ST6, CPN1, or DAB21P, or unidentified genetic causes

Source Documents