From the Guidelines
Hepatitis C treatment should primarily involve direct-acting antiviral (DAA) medications, such as glecaprevir/pibrentasvir or sofosbuvir/velpatasvir, which can cure over 95% of infections with an 8-12 week course. The choice of treatment depends on the specific hepatitis C genotype, presence of cirrhosis, prior treatment history, and other medical conditions 1.
Treatment Options
- Glecaprevir/pibrentasvir (Mavyret) is typically taken as three pills once daily with food for 8 weeks in most patients without cirrhosis, or 12 weeks in those with compensated cirrhosis 1.
- Sofosbuvir/velpatasvir (Epclusa) is taken as one pill daily for 12 weeks 1.
- Other options, such as sofosbuvir/velpatasvir/voxilaprevir, may also be considered in certain cases 1.
Baseline Testing and Follow-up
Before starting treatment, patients need baseline testing including HCV viral load, genotype determination, liver function tests, and assessment for cirrhosis 1. During treatment, side effects are generally mild and may include headache, fatigue, and nausea 1. Follow-up testing is essential, with HCV RNA testing 12 weeks after completing treatment to confirm cure (sustained virologic response) 1.
Special Considerations
In settings where none of the IFN-free, ribavirin-free options are available, options proposed in previous versions of the recommendations remain acceptable for patients likely to respond to these regimens until new DAAs become available and affordable 1. In low- and middle-income countries, the combination of generic sofosbuvir and daclatasvir is safe and well tolerated and provides high SVR rates at a very low price 1.
Treatment Choice
The treatment choice should be individualized based on the patient's specific characteristics, such as the presence of cirrhosis, prior treatment history, and other medical conditions 1. Early treatment is recommended for all patients with chronic hepatitis C to prevent progression to cirrhosis, liver cancer, and liver failure 1.
From the FDA Drug Label
There were 104 subjects enrolled, 82% were on hemodialysis, and 53%, 15%, 11%, 19%, 1% and 1% were infected with HCV genotypes 1,2,3,4,5 and 6, respectively. Overall, 19% of subjects had compensated cirrhosis and 81% of subjects were non-cirrhotic; 58% and 42% of subjects were treatment-naïve and PRS treatment-experienced, respectively The overall SVR12 rate was 98% and no subjects experienced virologic failure.
The study included subjects who were HCV treatment-naïve or treatment-experienced to combinations of (peg)interferon, ribavirin, and/or sofosbuvir, with the exception of genotype 3-infected subjects who were all treatment naïve
In EXPEDITION-2, the SVR12 rate in HCV/HIV-1 co-infected subjects was 98% (150/153). One subject experienced on-treatment virologic failure and no subjects relapsed.
The overall SVR12 rate in post-transplant subjects was 98% (98/100). There was one relapse and no on-treatment virologic failures.
The overall SVR12 rate was 98% in former/non-PWID subjects and 89% in current/recent PWID subjects;
The Hepatitis C treatment with glecaprevir (PO) has a high SVR12 rate of 98% in various patient populations, including those with compensated cirrhosis, treatment-naïve, and PRS treatment-experienced subjects.
- Key points:
- High SVR12 rate in different patient populations
- Effective in patients with compensated cirrhosis and non-cirrhotic patients
- Suitable for treatment-naïve and PRS treatment-experienced subjects
- Can be used in patients with HCV/HIV-1 co-infection and post-transplant patients
- Virologic failure rates are low, ranging from 0% to 2% in different studies 2
From the Research
Hepatitis C Treatment Overview
- Hepatitis C treatment has undergone significant transformations with the development of direct-acting antiviral (DAA) agents, offering high efficacy and minimal side effects 3.
- The current DAA regimens have high effectiveness and safety profiles, changing patient perception of HCV infection from a complex disease to a curable one after a single visit to the general practitioner 3.
Direct-Acting Antiviral Agents
- DAA agents have revolutionized HCV therapy, with the approval of ketoamide inhibitors boceprevir and telaprevir for use in genotype 1 HCV 4.
- Newer DAA agents with simplified dosing regimens and minimal toxicity are being developed, aiming to lead to viral eradication in most patients 4.
- Contemporary pan-genotypic combinations, such as sofosbuvir-velpatasvir and glecaprevir-pibrentasvir, have been shown to be safe and effective in treating acute and recent HCV infection 5.
Treatment Effectiveness
- The real-world effectiveness of DAA regimens against HCV genotype 3 infection has been analyzed, with pooled sustained virologic response (SVR) rates ranging from 84.97% to 98.54% for different regimens 6.
- The SVR rate was higher in non-cirrhotic patients (95.24%) compared to cirrhotic patients (89.39%), and in treatment-naive patients (94.41%) compared to treatment-experienced patients (87.98%) 6.
Emerging Direct-Acting Antiviral Agents
- The development of DAA agents has been driven by advances in molecular biology and understanding of HCV replication, with several classes of new and investigational DAA agents being developed 7.
- These novel medications interfere with critical steps in HCV replication and have the potential to significantly increase SVR rates, creating a revolution in the management of patients with chronic hepatitis C 7.