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Latin American experts identify cost and supply interruptions as major barriers to HAE managementExperts Align on New Treatment Options for Hereditary Angioedema

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Key Takeaway
Note that cost and supply interruptions are significant barriers to HAE management in Latin America.

This expert consensus guideline utilizes a Delphi process among 30 Latin American experts to assess the concordance between international HAE guidelines and regional clinical practice. The scope includes evaluating diagnostic work-up, genetic evaluation, first-line targeted long-term prophylaxis (LTP) using pdC1-INH, lanadelumab, and berotralstat, and the management of special populations.

Experts reached a prespecified consensus on core clinical management, including biochemical diagnostic work-up and the use of targeted therapies. However, the consensus process also identified significant systemic barriers to care. Specifically, 19/30 experts (63%) reported frequent or constant prophylaxis-supply interruptions, and 19/30 experts (63%) identified cost as a primary barrier. Additionally, 8/30 experts (27%) reported medicine availability as a barrier to optimal treatment.

The authors note that these findings are based on expert perceptions and were not independently verified against procurement, reimbursement, or inventory data. Consequently, the results may not represent national or regional health system averages. The findings are clinically relevant for identifying specific implementation priorities for HAE management in the Latin American region.

How this fits prior evidence

This consensus identifies specific regional barriers that extend the understanding of systemic hurdles in HAE care. It confirms that regulatory and financing barriers hinder optimal care delivery for hereditary angioedema in Balkan countries. It also highlights specific supply and cost issues in Latin America as barriers to providing the targeted therapies, such as lanadelumab and berotralstat, which have been shown to reduce attacks or improve tolerability in other contexts.

A group of 30 experts in Latin America participated in a study to see if local practices matched international guidelines for hereditary angioedema. They reached a consensus on several key areas, including the use of specific biochemical tests for diagnosis and the use of targeted long-term prevention therapies like pdC1-INH, lanadelumab, and berotralstat. They also agreed on the importance of routine monitoring and managing special patient groups.

While the experts agreed on these treatment goals, they also identified significant hurdles to making these treatments available to everyone. Specifically, 63 percent of the experts reported that high costs and frequent interruptions in the supply of medicine were major barriers. Another 27 percent of experts noted that the general availability of medicine was also a challenge.

It is important to note that these findings are based on the opinions and reports of a small group of experts. The data were not independently verified against official health system records or insurance data. Because these results reflect expert perceptions rather than a broad audit of the healthcare system, they should be viewed as a guide for identifying where improvements are needed in care.

What this means for you:
Experts agree on new treatment goals for hereditary angioedema but note that cost and supply issues remain barriers.

Common questions

What new treatments were discussed for hereditary angioedema?

Experts reached a consensus on using specific targeted long-term prevention therapies. These include pdC1-INH, lanadelumab, and berotralstat. They also agreed on the importance of using biochemical tests for diagnosis and providing on-demand therapy for patients.

What are the main challenges in treating this condition?

Experts identified several barriers to treatment. Specifically, 63 percent of the experts reported that high costs and frequent supply interruptions were major problems. Additionally, 27 percent of the experts reported that the general availability of medicine was a barrier to care.

How reliable are these findings for my specific situation?

These findings are based on the perceptions of 30 experts and were not verified against official health system data. Because they reflect expert opinions rather than a broad audit of the healthcare system, you should talk to your doctor about your specific treatment plan.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedOct 2026
View Original Abstract ↓
BackgroundCurrent international hereditary angioedema (HAE) guidelines and treat-to-target recommendations emphasize accurate diagnosis, early on-demand treatment, procedure-related short-term prophylaxis, individualized long-term prophylaxis (LTP), and routine assessment of disease control and quality of life. Evidence on implementation in Latin America remains limited. We aimed to assess concordance between international guidance and the consensus of a selected Latin American expert panel and to identify expert-reported implementation barriers.MethodsA scientific committee developed and externally validated a 74-item questionnaire (domains summarized in Supplementary Table S1) and conducted a two-round Delphi process among Latin American HAE experts. Consensus items were rated on a nine-point agreement scale, with consensus defined a priori as at least two-thirds of respondents scoring within a three-point band in the agreement or disagreement range. Descriptive items captured expert-reported diagnostic testing, treatment patterns, monitoring practices, and perceived implementation determinants. Consensus findings are summarized as meeting the prespecified threshold; descriptive findings are reported with item-specific n/N when available. Instrument validation (July-November 2024) showed high inter-rater agreement (Kendall W = 0.84; p < 0.001) and excellent internal consistency (Cronbach alpha = 0.92).ResultsThirty experts from 10 countries completed the process (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela). The prespecified consensus threshold was met for core biochemical diagnostic work-up, selective genetic evaluation, first-line targeted LTP (pdC1-INH, lanadelumab, and berotralstat), continued availability of on-demand therapy, routine monitoring, and management of special populations. The principal expert-reported implementation signal was limited feasibility: frequent or constant prophylaxis-supply interruptions were reported by 19/30 experts (63%), including 13/23 (57%) practicing in settings where public or insurance coverage was reported. Cost (19/30; 63%) and medicine availability (8/30; 27%) were the most frequently reported barriers. These reports were not independently verified against reimbursement, procurement, formulary, or inventory data.ConclusionWithin this selected panel, expert consensus was broadly concordant with international HAE guidance. Panelists reported barriers involving diagnostic testing, financing, medicine availability, and continuity of supply; however, these findings are perceptions and reported practices, not representative national or regional estimates or audited health-system data. They identify candidate implementation priorities that require confirmation through patient-level registries and objective access data.
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