Hepatitis C Virus Treatments
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.

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