Hepatitis C Virus Treatments

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HEPATITIS C VIRUS TREATMENT GUIDELINES
HEPATITIS C VIRUS TREATMENT GUIDELINES
Treatment naive Peg-IFN/ribavirin treatment experienced
Without cirrhosis With compensated cirrhosis Without cirrhosis With compensated cirrhosis
GENOTYPE 1A
Recommended

• Zepatier for 12wks1 OR

• Harvoni for 12wks2 OR

• Viekira Pak Or Viekira XR + ribavirin for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Epclusa for 12wks OR

• Daklinza + Sovaldi for 12wks

• Zepatier for 12wks1 OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Harvoni for 12wks OR

• Viekira Pak Or Viekira XR + ribavirin for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Epclusa for 12wks OR

• Daklinza + Sovaldi for 12wks

• Zepatier for 12wks1 OR

• Harvoni for 12wks OR

• Epclusa for 12wks

Alternative

Zepatier + ribavirin for 16wks3

• Viekira Pak4 Or Viekira XR4 + ribavirin for 24wks OR

• Olysio + Sovaldi +/− ribavirin for 24wks5 OR

• Daklinza + Sovaldi +/− ribavirin for 24wks OR

• Zepatier + ribavirin for 16wks3

Zepatier + ribavirin for 16wks3

• Viekira Pak4 Or Viekira XR4 + ribavirin for 24wks OR

• Harvoni for 24wks OR

• Zepatier + ribavirin for 16wks3 OR

• Daklinza + Sovaldi +/− ribavirin for 24wks OR

• Olysio + Sovaldi +/− ribavirin for 24wks6

GENOTYPE 1B
Recommended

• Zepatier for 12wks OR

• Harvoni for 12wks2 OR

• Viekira Pak Or Viekira XR for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Epclusa for 12wks OR

• Daklinza + Sovaldi for 12wks

• Zepatier for 12wks OR

• Harvoni for 12wks OR

• Viekira Pak4 Or Viekira XR4 for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Harvoni for 12wks OR

• Viekira Pak Or Viekira XR for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Epclusa for 12wks OR

• Daklinza + Sovaldi for 12wks

• Zepatier for 12wks OR

• Harvoni + ribavirin for 12wks OR

• Viekira Pak4 Or Viekira XR4 for 12wks OR

• Epclusa for 12wks

Alternative

• Daklinza + Sovaldi +/− ribavirin for 24wks OR

• Olysio + Sovaldi +/− ribavirin for 24wks

• Harvoni for 24wks OR

• Daklinza + Sovaldi +/− ribavirin for 24wks OR

• Olysio + Sovaldi +/− ribavirin for 24wks

GENOTYPE 2
Recommended
Epclusa for 12wks Epclusa for 12wks Epclusa for 12wks Epclusa for 12wks
Alternative
Daklinza + Sovaldi for 12wks Daklinza + Sovaldi for 16–24wks Daklinza + Sovaldi for 12wks Daklinza + Sovaldi for 16–24wks
GENOTYPE 3
Recommended

• Daklinza + Sovaldi for 12wks OR

• Epclusa for 12wks

• Epclusa7 for 12wks OR

• Daklinza + Sovaldi7 +/− ribavirin for 24wks

• Daklinza + Sovaldi7 for 12wks OR

• Epclusa7 for 12wks

• Zepatier + Sovaldi for 12wks OR

• Epclusa + ribavirin for 12wks

Alternative
Daklinza + Sovaldi + ribavirin for 24wks
GENOTYPE 4
Recommended

• Technivie + ribavirin for 12wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks OR

• Harvoni for 12wks

• Technivie4 + ribavirin for 12wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks OR

• Harvoni for 12wks

• Technivie + ribavirin for 12wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks8 OR

• Harvoni for 12wks

• Technivie4 + ribavirin for 12wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks8 OR

• Harvoni + ribavirin for 12wks

Alternative
Harvoni for 24wks9
GENOTYPE 5, 6
Recommended

• Epclusa for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Harvoni for 12wks

 
PHARMACOLOGICAL THERAPIES
Generic Brand Form Strength Dosage
OPIOID AGONIST
ribavirin Copegus tabs 200mg Take with food. Weight-based dosing (<75kg: 1000mg/day; ≥75kg: 1200mg/day in 2 divided doses). See full labeling.
daclatasvir Daklinza tabs 30mg, 60mg, 90mg 60mg once daily. Concomitant strong CYP3A inhibitors10, PIs, cobicistat-containing regimens (except with darunavir): 30mg once daily. Concomitant moderate CYP3A inducers:11 90mg once daily
sofosbuvir/​velpatasvir Epclusa tabs 400mg/​100mg 1 tab once daily
ledipasvir/​sofosbuvir Harvoni tabs 90mg/​400mg 1 tab once daily
simeprevir Olysio caps 150mg 1 cap once daily with food
sofosbuvir Sovaldi tabs 400mg 1 tab once daily
ombitasvir/​paritaprevir/​ritonavir Technivie tabs 12.5mg/​75mg/​50mg 2 tabs once daily in AM with a meal
ombitasvir/​paritaprevir/​ritonavir and dasabuvir Viekira Pak tabs 12.5mg/​75mg/​50mg and 250mg Take with a meal. 2 tabs ombitasvir/​paritaprevi/​ritonavir once daily (in AM) and 1 tab dasabuvir twice daily (AM & PM)
Viekira XR ext-rel tabs 8.33mg/​50mg/​33.33mg/​200mg 3 tabs once daily with a meal
elbasvir/​grazoprevir Zepatier tabs 50mg/​100mg 1 tab once daily
NOTES

For recommended and alternative regimens for specific patient populations (eg, treatment-experienced patients previously treated with regimens other than PEG-IFN/ribavirin, decompensated cirrhosis, HIV/HCV co-infection, renal impairment, etc), refer to the full guideline or drug manufacturer's labeling.

 

1 No baseline NS5A RASs for elbasvir detected. Includes G1a substitutions at amino acid positions 28, 30, 31, or 93.

2 An 8-week duration is recommended for treatment-naïve patients without cirrhosis who are non-black, HIV uninfected, and whose HCV RNA level is <6 million IU/ml.

3 Patients who have baseline NS5A RASs for elbasvir. Includes G1a substitutions at amino acid positions 28, 30, 31, or 93.

4 Reference FDA warning regarding use of ombitasvir/paritaprevir/ritonavir +/− dasabuvir in patients with cirrhosis.

5 Patients in whom no Q80K substitution is detected.

6 Alternative only for patients who are negative for the Q80K substitution by commercially available resistance assay. Other recommended or alternative regimens should be used for patients with genotype 1a compensated cirrhosis in whom the Q80K substitution is present.

7 RAS testing for Y93H is recommended and ribavirin should be included in regimen if present.

8 12 weeks is recommended for patients who experience virologic relapse after PEG-IFN/ribavirin therapy. Patients with prior on-treatment virologic failure (failure to suppress or breakthrough) while on PEG-IFN/ribavirin should be treated with 16 weeks and have weight-based ribavirin added.

9 For patients ineligible for ribavirin.

10 Strong inhibitors (eg, clarithromycin, itraconazole, ketoconazole, ritonavir, nefazodone).

11 Strong inducers (eg, bosentan, dexamethasone, efavirenz, etravirine, modafinil, nafcillin, rifapentine, nevirapine).

REFERENCES

AASLD-IDSA. HCV Guidance: Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed June 23, 2017.

(Rev. 9/2017)

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