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C1 INHIBITOR INJ,PWDR

Clinical Criteria Summary

Document 907: C1 Inhibitor BERINERT RUCONEST HAE Acute Treatment CFU

Exclusion Criteria

  • Concomitant use with another acute therapy agent for HAE (e.g., icatibant, ecallantide, or sebetralstat)

Inclusion Criteria

  • Restricted to VA / VA Community Care allergy/immunology, dermatology, or emergency medicine providers or locally designated expert
  • Suspected bradykinin-mediated angioedema

Document 908: C1 Inhibitor CINRYZE HAEGARDA HAE Prophylaxis CFU

⇄ This criteria document covers 2 drugs .
See all drugs in this document
  • C1 INHIBITOR INJ,PWDR
  • C1 INHIBITOR INJ,SOLN

Indication & Clinical Use

  • C1 Inhibitor (CINRYZE, HAEGARDA) for Hereditary Angioedema
  • Prophylaxis (long-term prophylaxis for HAE attacks or short-term prophylaxis prior to procedures or intubation)

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., berotralstat, donidalorsen, or lanadelumab)

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

Laboratory & Diagnostic Requirements

  • 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

Source Documents