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

• Mavyret for 8wks OR

• Harvoni for 12wks2 OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Mavyret for 12wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Epclusa for 12wks OR

• Mavyret for 12wks

Alternative

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

• Olysio + Sovaldi for 12wks OR

• Daklinza + Sovaldi for 12wks OR

• Zepatier + ribavirin for 16wks3

Zepatier + ribavirin for 16wks3

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

• Olysio + Sovaldi for 12wks OR

• Daklinza + Sovaldi for 12wks OR

• Zepatier + ribavirin for 16wks3

• Harvoni + ribavirin for 12wks OR

• Zepatier + ribavirin for 16wks3

GENOTYPE 1B
Recommended

• Zepatier for 12wks OR

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Mavyret for 12wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Epclusa for 12wks OR

• Mavyret for 12wks

Alternative

• Viekira Pak Or Viekira XR for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Daklinza + Sovaldi for 12wks

• Viekira Pak4 Or Viekira XR4 for 12wks

• Viekira Pak Or Viekira XR for 12wks OR

• Olysio + Sovaldi for 12wks OR

• Daklinza + Sovaldi for 12wks

• Harvoni + ribavirin for 12wks OR

• Viekira Pak4 Or Viekira XR4 for 12wks

GENOTYPE 2
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks

• Epclusa for 12wks OR

• Mavyret for 12wks

• Mavyret for 8wks OR

• Epclusa for 12wks

• Epclusa for 12wks OR

• Mavyret for 12wks

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

• Mavyret for 8wks OR

• Epclusa for 12wks

• Mavyret for 12wks OR

• Epclusa for 12wks7

• Epclusa for 12wks7

• Zepatier + Sovaldi for 12wks OR

• Vosevi for 12wks

Alternative

• Daklinza + Sovaldi for 12wks

• Vosevi for 12wks7 OR

• Daklinza + Sovaldi +/− ribavirin for 24wks7

• Daklinza + Sovaldi for 12wks7 OR

• Mavyret for 16wks OR

• Vosevi for 12wks7

• Epclusa + ribavirin for 12wks OR

• Mavyret for 16wks

GENOTYPE 4
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Mavyret for 12wks OR

• Zepatier for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Mavyret for 8wks OR

• Zepatier for 12wks8 OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Zepatier for 12wks8 OR

• Mavyret for 12wks

Alternative
Technivie + ribavirin for 12wks Technivie4 + ribavirin for 12wks

• Technivie + ribavirin for 12wks OR

• Zepatier + ribavirin for 16wks8

• Technivie4 + ribavirin for 12wks OR

• Zepatier + ribavirin for 16wks8 OR

• Harvoni + ribavirin for 12wks

GENOTYPE 5, 6
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks OR

• Harvoni for 12wks

• Mavyret for 12wks OR

• Epclusa for 12wks OR

• Harvoni for 12wks

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Mavyret for 12wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

 
PHARMACOLOGICAL THERAPIES
Generic Brand Strength Form Dosage
daclatasvir Daklinza 30mg, 60mg, 90mg tabs 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
elbasvir/​grazoprevir Zepatier 50mg/100mg tabs 1 tab once daily
glecaprevir/​pibrentasvir Mavyret 100mg/​40mg tabs 3 tabs once daily with food
ledipasvir/​sofosbuvir Harvoni 90mg/​400mg tabs 1 tab once daily
ombitasvir/​paritaprevir/​ritonavir Technivie 12.5mg/​75mg/​50mg tabs 2 tabs once daily in AM with a meal
ombitasvir/​paritaprevir/​ritonavir and dasabuvir Viekira Pak 12.5mg/​75mg/​50mg and 250mg tabs Take with a meal. 2 tabs ombitasvir/​paritaprevir/​ritonavir once daily (in AM) and 1 tab dasabuvir twice daily (AM & PM)
Viekira XR 8.33mg/​50mg/​
33.33mg/​200mg
ext-rel tabs 3 tabs once daily with a meal
ribavirin Copegus 200mg tabs Take with food. Weight-based dosing (<75kg: 1000mg/​day; ≥75kg: 1200mg/​day in 2 divided doses). See full labeling.
simeprevir Olysio 150mg caps 1 cap once daily with food
sofosbuvir Sovaldi 400mg tabs 1 tab once daily
sofosbuvir/​velpatasvir Epclusa 400mg/​100mg tabs 1 tab once daily
sofosbuvir/​velpatasvir/​voxilaprevir Vosevi 400mg/​100mg/​100mg tabs 1 tab once daily with food
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 Patients with 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 (risk of hepatic decompensation/hepatic failure).

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 Baseline RAS testing for Y93H is recommended. Ribavirin should be included in regimen or consider Vosevi 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 December 15, 2017.

(Rev. 1/2018)

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