Drug Treatment for Hepatitis C Virus Infection
| DRUG TREATMENT FOR HEPATITIS C VIRUS INFECTION | ||
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Characteristics of Persons for Whom Therapy is Widely Accepted¹: • Age ≥18 years; Hepatitis C Virus (HCV)-RNA serum positive • Compensated liver disease (total serum bilirubin <1.5g/dL; INR 1.5; serum albumin >3.4; platelet count 75,000mm; and no evidence of hepatic decompensation (hepatic encephalopathy or ascites) • Acceptable hematological and biochemical indices: Hemoglobin 13g/dL for men and 12g/dL for women; neutrophil count 1500/mm3 and serum creatinine <1.5mg/dL Dose modifications: This table refers to usual initial dosing of therapy based on manufacturers' prescribing information. For more information regarding dose modification and reductions, see drug monographs at www.eMPR.com or individual PI. |
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| Brand | Generic | Usual Dosage |
| DUAL THERAPY | ||
| Infergen* + ribavirin** | interferon alfacon-1 | Adults: 15mcg SC once daily + ribavirin 1000mg (<75kg) or 1200mg (≥75kg) in 2
divided doses up to 48wks.
Children: Not recommended. |
| Intron A + Rebetol** | interferon alfa-2b + ribavirin | Adults: ≥18yrs: 3million Units SC three times weekly + Rebetol 1000mg (≤75kg) or
1200mg (>75kg) in 2 divided doses for 24–48wks; Retreatment: 24wks.
Children: ≥3yrs: 25–61kg: 3million Units/m² SC three times weekly + 15mg/kg/day Rebetol divided in AM & PM for 48wks (genotype 1) or 24wks (genotype 2,3). |
| Pegasys* + Copegus** | peginterferon alfa-2a + ribavirin | Adults: ≥18yrs: Genotype 1,4: 180mcg SC once weekly + Copegus 1000mg
(<75kg) or 1200mg (≥75kg) in 2 divided doses up to 48wks.
Genotype 2,3: 180mcg SC once weekly + 800mg Copegus for 24wks in 2 divided doses. Children: ≥5yrs: 180mcg/1.73m²/wk SC + 15mg/kg/day Copegus divided in AM & PM for 48wks (genotype 1) or 24wks (genotype 2,3); see literature. |
| PegIntron* + Rebetol** | peginterferon alfa-2b + ribavirin | Adults: ≥18yrs: 1.5mcg/kg/wk SC + Rebetol 800mg (≤65kg) or 1000mg
(>65–80kg) or 1200mg (>80kg) or 1400mg (>105kg) for 48wks (genotype 1) or 24wks (genotype 2,3).
Retreatment: 48wks. Prior treatment failure: Add HCV NS3/4A Protease Inhibitor (unless contraindicated);
treat for 48wks.
Children: 3–17yrs: 60mcg/m²/wk SC + 15mg/kg/day Rebetol in 2 divided doses for 48wks (genotype 1) or 24wks (genotype 2, 3). |
| TRIPLE THERAPY | ||
| Incivek† + peginterferon alfa & ribavirin | telaprevir | Adults: 750mg three time daily with non low fat food for 12wks with peginterferon
alfa + ribavirin. Then continue peginterferon + ribavirin according to HCV-RNA response at Weeks 4 and 12
(see literature).
Children: Not recommended. |
| Victrelis† + peginterferon alfa & ribavirin | boceprevir | Adults: Initiate peginterferon alfa + ribavirin for 4wks. Then add 800mg Victrelis
three times daily to therapy. (Patients without cirrhosis: continue treatment as indicated by HCV-RNA
levels at Weeks 8, 12, and 24 (see literature). (With cirrhosis: continue for 44wks.
Children: Not recommended. |
| MONOTHERAPY | ||
| Infergen*‡ | interferon alfacon-1 | Adults: 9mcg SC three times weekly for 24wks. Retreatment if tolerated: 15mcg SC
three times weekly for up to 48wks.
Children: Not recommended. |
| Intron A | interferon alfa-2b | Adults: 3million Units SC or IM three times weekly for 16wks; if tolerated with
normalization of ALT: continue 18–24 months (72–96wks).
Children: Monotherapy not recommended. |
| Pegasys*‡ | peginterferon alfa-2a | Adults: 180mcg SC once weekly for 48wks.
Children: Not recommended. |
| PegIntron*‡ | peginterferon alfa-2b | Adults: 1mcg/kg/wk SC for 1 year administered on same day of the week.
Children: Not recommended. |
| NOTES | ||
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¹ Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, Management, and Treatment of Hepatitis C: An Update. Hepatology. 2009; 49(4). * Patients who fail to achieve a 2 log10 drop at 12 weeks or undetectable HCV-RNA at Week 24 are highly unlikely to achieve SVR and discontinuation of therapy should be considered. ** Ribavirin should be taken orally with food. Do not use with creatinine clearance <50mL/min. Take in 2 divided doses (AM & PM): see literature. † Indicated for the treatment of chronic hepatitis C genotype 1 infection for combination therapy only. ‡ Drug is not recommended as monotherapy unless patient cannot take ribavirin as combination treatment. IM = intramuscularly; mcg = microgram; SC = subcutaneously; SVR = sustained virologic response; wks = weeks (Rev. 4/2013) |
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