Patisiran for intravenous infusion (Onpattro™)


Indications for Prior Authorization:
  • Treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults
Patients must meet the following criteria for the indication(s) above:
  • Diagnosis of polyneuropathy of hereditary amyloid transthyretin-mediated amyloidosis (hATTR), AND
  • Is prescribed by or in consultation with a neruologist, geneticist, or a physician who specializes in the treatment of amyloidosis, AND
  • The patient is 18 years of age or older, AND
  • The patient has a documented transthyretin (TTR) mutation verified by genetic testing, AND
  • The patient has symptomatic peripheral neuropathy (e.g., reduced motor strength/coordination, impaired sensation [e.g., pain, temperature, vibration, touch])
  • For patients weighing < 100 kg: the recommended dosage is 0.3 mg/kg intravenously (IV) once every 3 weeks
  • For patients weighing ≥ 100 kg: the recommended dosage is 30 mg IV once every 3 weeks 
  • Onpattro should be administered by a healthcare professional along with premedications to reduce risk of infusion-related reactions
  • One year

Last review date: June 10, 2019

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