Copyright
©The Author(s) 2018.
World J Hepatol. Oct 27, 2018; 10(10): 670-684
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.670
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.670
Table 1 Direct acting anti-viral agents with posology
| No. | Trade name | Generic name with doses |
| 1 | Sovaldi | Sofosbuvir 400 mg |
| 2 | Olysio | Simeprevir 150 mg |
| 3 | Daklinza | Daclatasvir 30 mg/60 mg/90 mg |
| 4 | Harvoni | Ledipasvir 90 mg/Sofosbuvir 400 mg |
| 5 | Viekira Pak | 1 d pack contains Paritaprevir 75 mg/Ombitasvir 12.5 mg/Ritonavir 50 mg tablet × 2 and Dasabuvir 250 mg tablet × 2 |
| 6 | Viekira XR | Extended release tablet contains Dasabuvir 200 mg/ombitasvir 8.33 mg/Paritaprevir 50 mg/Ritonavir 33.33 mg |
| 7 | Technivie | Ombitasvir 12.5 mg/Paritaprevir 75 mg/Ritonavir 50 mg |
| 8 | Epclusa | Sofosbuvir 400 mg/ Velpatasvir 100 mg |
| 9 | Zepatier | Elbasvir 50 mg/ Grazoprevir 100 mg |
| 10 | Mavyret | Glecaprevir 100 mg/ Pibrentasvir 40 mg |
| 11 | Vosevi | Sofosbuvir 400 mg/Velpatasvir 100 mg/Voxilaprevir 100 mg |
Table 2 Genotype 1a and 1b infection - treatment-naïve (with compensated cirrhosis) and non-cirrhotic
| No. | First line therapy | Alternative regimen |
| Genotype 1a infection - treatment-naïve and non-cirrhotic | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk | Paritaprevir/ritonavir/ombitasvir and dasabuvir (in Viekira Pak and Viekira XR) with weight-based ribavirin - 12 wk |
| 2 | Elbasvir/Grazoprevir (Zepatier) for patients without baseline NS5A RAVs for Elbasvir - 12 wk | Simeprevir (Olysio) plus Sofosbuvir (Sovaldi) - 12 wk |
| 3 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk < Ledipasvir/Sofosbuvir (Harvoni) - 8 wk in non-black, HIV-uninfected individuals with serum HCV RNA < 6 million units/mL | Daclatasvir(Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk |
| 4 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | Elbasvir/Grazoprevir (Zepatier) with weight-based ribavirin for patients with baseline NS5A RAVs for Elbasvir - 16 wk |
| Genotype 1a infection - treatment-naïve with compensated cirrhosis | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Elbasvir/Grazoprevir (Zepatier) with weight-based ribavirin for patients with baseline NS5A RASs for Elbasvir - 16 wk |
| 2 | Elbasvir/Grazoprevir (Zepatier) for patients without baseline NS5A RAVs for Elbasvir - 12 wk | |
| 3 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk | |
| 4 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| Genotype 1b infection - treatment-naïve and non-cirrhotic | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk | Paritaprevir/ritonavir/ombitasvir and dasabuvir (in Viekira Pak and Viekira XR) - 12 wk |
| 2 | Elbasvir/Grazoprevir (Zepatier) - 12 wk | Simeprevir (Olysio) plus Sofosbuvir (Sovaldi) - 12 wk |
| 3 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk < Ledipasvir/Sofosbuvir (Harvoni - 8 wk in non-black, HIV-uninfected individuals with serum HCV RNA < 6 million units/mL | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk |
| 4 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| Genotype 1b infection - treatment-naïve with compensated cirrhosis | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Paritaprevir/ritonavir/ombitasvir and dasabuvir (in Viekira Pak and Viekira XR) - 12 wk |
| 2 | Elbasvir/Grazoprevir (Zepatier - 12 wk | |
| 3 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk | |
| 4 | Sofosbuvir/Velpatasvir (Epclusa - 12 wk | |
Table 3 Genotype 1 infection-treatment-experienced
| Glecaprevir/Pibrentasvir (Mavyret): Duration of treatment depends on previous regimen and presence or absence of compensated cirrhosis. | ||
| Previous regimen | No cirrhosis | Compensated cirrhosis |
| Pegylated IFN, ribavirin and/or Sofosbuvir but no prior exposure to NS3/4A PI or NS5A inhibitor | 8 wk | 12 wk |
| NS3/4A PI but no prior exposure to NS5A inhibitor | 12 wk | 12 wk |
| NS5A inhibitor but no prior exposure to NS3/4A PI | 16 wk | 16 wk |
| Elbasvir/Grazoprevir (Zepatier): Duration depends on viral load irrespective of no cirrhosis or compensated cirrhosis as per EASL guideline. | ||
| Previous regimen | HCV RNA ≤ 800000 IU/mL | HCV RNA > 800000 IU/mL |
| Pegylated IFN and ribavirin | 12 wk without ribavirin | 16 wk with ribavirin |
| Ledipasvir/Sofosbuvir (Harvoni): Applicable for both non-cirrhotics andcompensated cirrhotics. | ||
| Previous regimen | With ribavirin | Without ribavirin |
| PEG IFN and ribavirin | 12 wk | 24 wk |
| Sofosbuvir/Velpatasvir (Epclusa): Treatment is same for both non-cirrhotics and compensated cirrhotics. | ||
| Previous regimen | No cirrhosis | Compensated cirrhosis |
| PEG IFN and ribavirin | 12 wk without ribavirin | 12 wk without ribavirin |
| Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi): Applicable for both non-cirrhotics and compensated cirrhotics. | ||
| Previous regimen | With ribavirin | Without ribavirin |
| PEG IFN and ribavirin | 12 wk | 24 wk |
| Paritaprevir/ritonavir/ombitasvir and dasabuvir (in Viekira Pak and Viekira XR) with weight-based ribavirin. | ||
| Previous regimen | No cirrhosis | Compensated cirrhosis |
| PEG IFN and ribavirin | 12 wk | 24 wk |
Table 4 Genotype 2-4 infection - treatment-naïve (with compensated cirrhosis) and non-cirrhotic
| No. | First line therapy | Alternative regimen |
| Genotype 2 infection - treatment-naïve and non-cirrhotic | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk | Daclatasvir(Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| Genotype 2 infection - treatment-naïve with compensated cirrhosis | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Daclatasvir(Daklinza) plus Sofosbuvir (Sovaldi) - 16 to 24 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| Genotype 3 infection - treatment-naïve and non- cirrhotic | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa - 12 wk | |
| Genotype 3 infection - treatment-naïve with compensated cirrhosis | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Vosevi - Sofosbuvir 400 mg/ Velpatasvir 100 mg/ Voxilaprevir 100 mg when Y93 is present - 12 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with or without weight-based ribavirin - 24 wk |
| Genotype 4 infection - treatment-naïve and non-cirrhotic | ||
| 1 | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk | Ombitasvir 25 mg/Paritaprevir 150 mg/ Ritonavir 100 mg (Technivie) with weight-based ribavirin - 12 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| 3 | Elbasvir/Grazoprevir (Zepatier) - 12 wk | |
| 4 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk | |
| Genotype 4 infection - treatment-naïve with compensated cirrhosis | ||
| 1 | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | Ombitasvir 25 mg/Paritaprevir 150 mg/ Ritonavir 100 mg (Technivie) with weight-based ribavirin - 12 wk |
| 2 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | |
| 3 | Elbasvir/Grazoprevir (Zepatier) - 12 wk | |
| 4 | Ledipasvir/Sofosbuvir (Harvoni) - 12 wk | |
Table 5 Genotype 5 or 6 infection - treatment-naïve with and without compensated cirrhosis
| No. | DAA | No cirrhosis | Compensated cirrhosis |
| 1 | Glecaprevir/Pibrentasvir (Mavyret) | 8 wk | 12 wk |
| 2 | Sofosbuvir/Velpatasvir (Epclusa) | 12 wk | 12 wk |
| 3 | Ledipasvir/Sofosbuvir (Harvoni) | 12 wk | 12 wk |
Table 6 Genotype 2-6 infection - treatment-experienced
| First line therapy | Alternative regimen | |
| Genotype 2 infection - treatment-experienced | ||
| Pegylated IFN/ribavirin-experienced without cirrhosis | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk or Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk |
| Pegylated IFN/ribavirin-experienced with compensated cirrhosis | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) - 16 to 24 wk |
| Sofosbuvir plus ribavirin-experienced with or without compensated cirrhosis | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | |
| Genotype 3 infection - treatment-experienced | ||
| Pegylated IFN/ ribavirin-experienced without cirrhosis | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) - 12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 16 wk or Sofosbuvir/Velpatasvir/Voxilaprevir - 12 wk |
| Pegylated IFN/ ribavirin-experienced with compensated cirrhosis | Elbasvir/Grazoprevir (Zepatier) - 12 wk or Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) -12 wk | Sofosbuvir/Velpatasvir (Epclusa) plus weight-based ribavirin - 12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 16 wk |
| DAA-experienced including NS5A inhibitors with or without compensated cirrhosis | Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) - 12 wk or in case of NS5A inhibitor failure and cirrhosis - Vosevi plus weight-based Ribavirin - 12 wk | |
| Genotype 4 infection - treatment-experienced | ||
| Pegylated IFN/ ribavirin-experienced without cirrhosis | Sofosbuvir/Velpatasvir (Epclusa) -12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 8 wk or Elbasvir/Grazoprevir (Zepatier) in virologic relapse - 12 wk or Ledipasvir/Sofosbuvir (Harvoni) - 12 wk | Ombitasvir 25 mg/Paritaprevir 150 mg/Ritonavir 100 mg plus weight based Ribavirin - 12 wk or Elbasvir/Grazoprevir (Zepatier) with weight-based Ribavirin (in case of prior on-treatment virologic failure) - 16 wk |
| Pegylated IFN/ ribavirin-experienced with compensated cirrhosis | Sofosbuvir/Velpatasvir (Epclusa) - 12 wk or Elbasvir/Grazoprevir (Zepatier) in virologic relapse - 12 wk or Glecaprevir/Pibrentasvir (Mavyret) - 12 wk | Ombitasvir 25 mg/Paritaprevir 150 mg/ Ritonavir 100 mg plus weight based Ribavirin - 12 wk or Elbasvir/Grazoprevir (Zepatier) with weight-based Ribavirin (in case of prior on-treatment virologic failure - 16 wk or Ledipasvir/Sofosbuvir (Harvoni) plus weight-based Ribavirin) - 12 wk |
| DAA-experienced including NS5A inhibitors with or without compensated cirrhosis | Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) - 12 wk | |
| Genotype 5 or 6 infection - treatment-experienced (recommended regimen) | ||
| Pegylated IFN/ ribavirin-experienced with or without compensated cirrhosis | Glecaprevir/Pibrentasvir (Mavyret) - 8 wk for patients without cirrhosis and 12 wk for patients with compensated cirrhosis or Ledipasvir/Sofosbuvir (Harvoni) plus weight-based Ribavirin - 12 wk or Sofosbuvir/Velpatasvir (Epclusa) - 12 wk | |
| DAA-experienced including NS5A inhibitors with or without compensated cirrhosis | Sofosbuvir/Velpatasvir/ Voxilaprevir (Vosevi) - 12 wk | |
Table 7 Recommended and alternative therapy
| Genotype | Treatment-naïve and - experienced patients with HCV infection in the allograft without cirrhosis | Treatment-naïve and - experienced patients with HCV infection in the allograft with compensated cirrhosis | Treatment-naïve and - experienced patients with HCV infection in the allograft with decompensated cirrhosis |
| Recommended therapy | |||
| 1, 4, 5 or 6 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk or Ledipasvir/Sofosbuvir (Harvoni) for 12 wk | Ledipasvir/Sofosbuvir (Harvoni) with weight-based ribavirin - 12 wk | Ledipasvir/Sofosbuvir (Harvoni) with initial low dose of ribavirin (600 mg), increase the dose as tolerated - 12 wk |
| 2 or 3 | Glecaprevir/Pibrentasvir (Mavyret) - 12 wk or Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with initial low dose of ribavirin (600 mg), increase the dose as tolerated for 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with initial low dose of ribavirin (600 mg), increase the dose as tolerated - 12 wk | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with initial low dose of ribavirin (600 mg), increase the dose as tolerated for 12 wk or Sofosbuvir/Velpatasvir (Epclusa) with weight-based ribavirin - 12 wk |
| Alternative therapy | |||
| 1, 4, 5 or 6 | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with initial low dose of ribavirin (600 mg), increase the dose as tolerated for 12 wk or HCV genotype 1 or 4 infection only: Simeprevir (Olysio) plus Sofosbuvir (Sovaldi) with or without weight-based ribavirin | Daclatasvir (Daklinza) plus Sofosbuvir (Sovaldi) with initial low dose of ribavirin (600 mg), increase the dose as tolerated for 12 wk or HCV genotype 1 or 4 infection only: Simeprevir (Olysio) plus Sofosbuvir (Sovaldi) with or without weight-based ribavirin | |
| 2 or 3 | Glecaprevir/Pibrentasvir (Mavyret) for 12 wk or Sofosbuvir/Velpatasvir (Epclusa) with weight-based ribavirin for 12 wk | ||
- Citation: Ahmed M. Era of direct acting anti-viral agents for the treatment of hepatitis C. World J Hepatol 2018; 10(10): 670-684
- URL: https://www.wjgnet.com/1948-5182/full/v10/i10/670.htm
- DOI: https://dx.doi.org/10.4254/wjh.v10.i10.670