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| HEPATITIS C VIRUS TREATMENTS | |||
|---|---|---|---|
| Hepatitis C virus (HCV) management for treatment-naive patients is based on HCV genotype and the presence or absence of cirrhosis. The following lists the recommended treatments and duration of therapy for genotypes 1 through 6. For management of treatment-experienced patients or those with multiple treatment failures, please refer to the AASLD-IDSA’s HCV guidelines or the full drug labeling. | |||
| Genotype | Without Cirrhosis | With Compensated Cirrhosis | With Decompensated Cirrhosis1 |
| TREATMENT NAIVE | |||
| Genotype 1a | • Mavyret for 8wks OR • Harvoni for 12wks2 OR • Epclusa for 12wks
Alternative: • Zepatier for 12wks |
• Harvoni for 12wks OR • Epclusa for 12wks OR • Mavyret for 8wks
Alternative: • Zepatier for 12wks |
• Harvoni + ribavirin4 for 12wks OR • Epclusa + ribavirin6 for 12wks OR • Harvoni for 24wks OR • Epclusa for 24wks |
| Genotype 1b | • Zepatier for 12wks5 OR • Mavyret for 8wks OR • Harvoni for 12wks2,7 OR • Epclusa for 12wks |
• Zepatier for 12wks OR • Harvoni for 12wks OR • Epclusa for 12wks OR • Mavyret for 8wks |
• Harvoni + ribavirin4 for 12wks OR • Epclusa + ribavirin6 for 12wks OR • Harvoni for 24wks OR • Epclusa for 24wks |
| Genotype 2 | • Mavyret for 8wks OR • Epclusa for 12wks |
• Epclusa for 12wks OR • Mavyret for 8wks |
• Epclusa + ribavirin6 for 12wks OR • Epclusa for 24wks |
| Genotype 3 | • Mavyret for 8wks OR • Epclusa for 12wks |
• Mavyret for 8wks OR • Epclusa for 12wks3
Alternative: • Epclusa + ribavirin for 12wks3 OR • Vosevi for 12wks3 |
• Epclusa + ribavirin6 for 12wks OR • Epclusa for 24wks |
| Genotype 4 | • Zepatier for 12wks OR • Mavyret for 8wks OR • Harvoni for 12wks8 OR • Epclusa for 12wks |
• Epclusa for 12wks OR • Mavyret for 8wks5 OR • Zepatier for 12wks OR • Harvoni for 12wks |
• Harvoni + ribavirin4 for 12wks OR • Epclusa + ribavirin6 for 12wks OR • Harvoni for 24wks OR • Epclusa for 24wks |
| Genotypes 5 or 6 | • Mavyret for 8wks OR • Epclusa for 12wks OR • Harvoni for 12wks9 |
• Mavyret for 8wks OR • Epclusa for 12wks OR • Harvoni for 12wks9 |
• Harvoni + ribavirin4 for 12wks OR • Epclusa + ribavirin6 for 12wks OR • Harvoni for 24wks OR • Epclusa for 24wks |
| PHARMACOLOGICAL THERAPIES | ||||
| Generic | Brand | Strength | Form | Dose |
|---|---|---|---|---|
| elbasvir/grazoprevir | Zepatier | 50mg/100mg | tabs | Adults and Children: <12yrs (<30kg): not established. ≥12yrs or ≥30kg: 1 tab once daily. |
| glecaprevir/pibrentasvir | Mavyret | 100mg/40mg | tabs | Adults and Children: <3yrs: not established. ≥3yrs (<20kg): 150mg/60mg (pellets) once daily; (20–<30kg): 200mg/80mg (pellets) once daily; (30–<45kg): 250mg/100mg (pellets) once daily; (≥45kg): 300mg/120mg (tabs or pellets) once daily. ≥12yrs: 300mg/120mg (tabs or pellets) once daily. |
| Mavyret Oral Pellets | 50mg/20mg | pellets | ||
| ledipasvir/sofosbuvir | Harvoni | 45mg/200mg, 90mg/400mg | tabs | Adults: 90mg/400mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 33.75mg/150mg (pellets) once daily; (17–<35kg): 45mg/200mg (tabs or pellets) once daily; (≥35kg): 90mg/400mg (tabs or pellets) once daily. |
| Harvoni Oral Pellets | 33.75mg/150mg, 45mg/200mg | pellets | ||
| ribavirin | — | 200mg | caps, tabs | Adults: Take with food in 2 divided doses.
≥18yrs (<75kg): 1g/day; (≥75kg): 1.2g/day. Low initial dose: 600mg; increase as tolerated. Children: <3yrs: not established. Take with food in 2 divided doses. ≥3yrs (<47kg): 15mg/kg/day; (47–49kg): 600mg/day; (50–65kg): 800mg/day; (66–80kg): 1g/day; (>80kg): 1.2g/day. Low initial dose: 600mg; increase as tolerated. |
| sofosbuvir | Sovaldi | 200mg, 400mg | tabs | Adults: 400mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 150mg (pellets) once daily; (17–<35kg): 200mg (tabs or pellets) once daily; (≥35kg): 400mg (tabs or pellets) once daily. |
| Sovaldi Oral Pellets | 150mg, 200mg | pellets | ||
| sofosbuvir/velpatasvir | Epclusa | 200mg/50mg, 400mg/100mg | tabs | Adults: 400mg/100mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 150mg/37.5mg (pellets) once daily; (17–<30kg): 200mg/50mg (tabs or pellets) once daily; (≥30kg): 400mg/100mg (tabs or pellets) once daily. |
| Epclusa Oral Pellets | 150mg/37.5mg, 200mg/50mg | pellets | ||
| sofosbuvir/velpatasvir/ voxilaprevir | Vosevi | 400mg/100mg/100mg | tabs | Adults: 1 tab once daily with food. Children: Not established. |
| NOTES | ||||
|
Key: AASLD-IDSA = American Association for the Study of Liver Diseases and Infectious Diseases Society of America; HCV = hepatitis C virus; PI = protease inhibitor
1 Includes Child-Turcotte-Pugh (CTP) class B and class C patients who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma. Any protease inhibitor-containing regimen (eg, glecaprevir, grazoprevir, voxilaprevir) and interferon-based regimens are not recommended. 2 An 8-week duration is recommended for treatment-naïve patients without cirrhosis who are HIV uninfected, and whose HCV RNA level is <6 million IU/ml. 3 Baseline NS5A RAS Y93H testing for velpatasvir is recommended. If baseline NS5A RAS Y93H is present, ribavirin should be added to the regimen, or change regimen to Vosevi. 4 Initiate with low-dose ribavirin (600mg) and increase as tolerated to weight-based dosing. 5 Duration of 12 weeks is recommended for HIV/HCV co-infection. 6 With weight-based ribavirin. For patients with CTP class C cirrhosis, initiate with low-dose ribavirin (600mg) and increase as tolerated. 7 Consider an 8-week regimen in patients with genotype 1b and mild fibrosis. 8 Consider an 8-week regimen in patients with favorable baseline characteristics (eg, no cirrhosis, HCV RNA <6 million IU/mL, absence of genotype 4r. 9 Not recommended for genotype 6e if subtype is known. 10 Consider extending treatment to 24wks in extremely difficult cases (eg, genotype 3 with cirrhosis or failure following Mavyret + Sovaldi regimen). 11 Not recommended in patients with prior exposure to an NS5A inhibitor plus NS3/4 PI regimens (eg, elbasvir/grazoprevir).
Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. |
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| REFERENCES | ||||
|
AASLD-IDSA. HCV Guidance: Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Updated October 24, 2022. Accessed October 27, 2022. Rev. 11/2022 |
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