From the Guidelines
The treatment for Hepatitis C (HCV) involves direct-acting antiviral (DAA) medications taken for 8-12 weeks, with cure rates exceeding 95%, and the standard first-line regimens include combinations like sofosbuvir/velpatasvir (Epclusa) or glecaprevir/pibrentasvir (Mavyret) 1.
Key Considerations
- The choice of treatment regimen depends on factors such as viral genotype, liver function, prior treatment history, and comorbidities.
- Before starting treatment, patients need assessment of liver fibrosis and screening for potential drug interactions.
- Treatment is typically one pill daily with minimal side effects like headache, fatigue, and nausea.
- Regular monitoring during treatment includes blood tests to assess viral load and liver function.
Treatment Goals
- The goal is to achieve sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after completing therapy, which indicates cure.
- These medications work by targeting specific proteins essential for viral replication, preventing the virus from multiplying and allowing the body to clear the infection.
Special Considerations
- For patients with decompensated cirrhosis or other complications, treatment should be managed by specialists and may require adjusted regimens 1.
- Patients with recently acquired de novo hepatitis C should be treated with the combination of sofosbuvir and velpatasvir or with the combination of glecaprevir and pibrentasvir for 8 weeks 1.
Patient Education
- Patients with HCV should receive counseling about transmission prevention, such as avoidance of sharing personal hygiene articles and avoidance of needle sharing in the setting of intravenous drug use 1.
- Patients do not need to avoid acetaminophen, although it is advisable to set a lower maximum daily dosage of 2 g rather than 4 g in patients with cirrhosis related to HCV 1.
From the FDA Drug Label
The overall SVR12 rate was 98% and no subjects experienced virologic failure. The presence of renal impairment did not affect efficacy; no dose-adjustments were required during the trial. In EXPEDITION-2, the SVR12 rate in HCV/HIV-1 co-infected subjects was 98% (150/153). The overall SVR12 rate in post-transplant subjects was 98% (98/100). The overall SVR12 rate was 98% in former/non-PWID subjects and 89% in current/recent PWID subjects;
The treatment for Hepatitis C (HCV) is MAVYRET (glecaprevir and pibrentasvir).
- Treatment duration: 8,12, or 16 weeks, depending on the patient's condition and history of treatment.
- Patient populations:
- Treatment-naïve or PRS treatment-experienced adults without cirrhosis or with compensated cirrhosis.
- Adults with HCV/HIV-1 coinfection without cirrhosis or with compensated cirrhosis.
- Adults with liver or kidney transplant without cirrhosis.
- People who inject drugs (PWID) and those on medication-assisted treatment (MAT) for opioid use disorder.
- Efficacy: High SVR12 rates (89-98%) were observed in different patient populations. 2
From the Research
Treatment for Hepatitis C
The treatment for Hepatitis C (HCV) has undergone significant advancements in recent years.
- Direct-acting antivirals (DAAs) have revolutionized the treatment of HCV, offering high sustained virological response (SVR) rates and shorter treatment durations 3.
- Several oral regimens combining DAAs from different families have been developed, resulting in SVR rates above 90% and treatment durations of 12 weeks or less 3.
- Real-world effectiveness studies have demonstrated high SVR rates for various DAA regimens, including sofosbuvir/velpatasvir and daclatasvir plus sofosbuvir, in patients with genotype 2 and 3 infections 4, 5.
Direct-Acting Antiviral Regimens
- Sofosbuvir/velpatasvir is a pangenotypic DAA combination that has been shown to be effective in treating patients with HCV genotype 1 through 6 6.
- Daclatasvir plus sofosbuvir and velpatasvir/sofosbuvir have been found to produce similar SVR rates in patients with genotype 2 and 3 infections 5.
- Sofosbuvir/velpatasvir/voxilaprevir is a DAA regimen that has been shown to be effective in treating DAA-experienced patients with genotype 1-4 infections 7.
Factors Affecting Treatment Outcomes
- Prior treatment experience and advanced liver disease have been found to be significant predictors of reduced SVR rates in patients with genotype 3 infections 5.
- The presence of cirrhosis and prior NS5A experience have also been found to affect treatment outcomes in DAA-experienced patients 7.
- The choice of DAA regimen does not appear to have a significant impact on SVR rates in patients with genotype 2 and 3 infections 5.