From the Guidelines
For patients with hepatitis C virus genotype 1a and compensated cirrhosis, the recommended antiviral regimen is either glecaprevir/pibrentasvir (Mavyret) for 8 weeks or sofosbuvir/velpatasvir (Epclusa) for 12 weeks, as these regimens have been shown to have high cure rates exceeding 95% for genotype 1a with compensated cirrhosis 1.
Key Considerations
- The choice of antiviral regimen should be based on the patient's HCV genotype, presence of cirrhosis, and other factors such as potential drug interactions and renal function.
- Patients should be assessed for hepatic function, potential drug interactions, and renal function before starting treatment.
- Monitoring during treatment includes checking for medication adherence and side effects.
Treatment Options
- Glecaprevir/pibrentasvir (Mavyret) for 8 weeks: This regimen is recommended for treatment-naive patients with genotype 1a and compensated cirrhosis 1.
- Sofosbuvir/velpatasvir (Epclusa) for 12 weeks: This regimen is also recommended for treatment-naive patients with genotype 1a and compensated cirrhosis 1.
- Ledipasvir/sofosbuvir (Harvoni) for 12 weeks: This regimen can be used as an alternative, but it may require the addition of ribavirin in certain cases 1.
- Elbasvir/grazoprevir (Zepatier) for 12 weeks: This regimen can be used as an alternative, but it is specifically effective for genotype 1a without baseline NS5A resistance-associated substitutions 1.
Goal of Treatment
- The goal of treatment is to achieve sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after completing treatment, which is considered a cure for hepatitis C.
- These regimens work by targeting specific proteins essential for HCV replication, with combination therapy preventing viral resistance.
From the Research
Antiviral Regimen for Hepatitis C, Genotype 1a with Compensated Cirrhosis
The recommended antiviral regimen for a patient with hepatitis C, genotype 1a (HCV Genotype 1a), and compensated cirrhosis includes:
- Glecaprevir plus pibrentasvir for 12 weeks, as shown in a study published in The Lancet. Infectious diseases 2
- Sofosbuvir/velpatasvir for 12 weeks, as demonstrated in a study published in Liver international : official journal of the International Association for the Study of the Liver 3
- Ledipasvir and sofosbuvir for 12 weeks, as evaluated in a study published in Hepatology (Baltimore, Md.) 4
Efficacy of Antiviral Regimens
The efficacy of these regimens is as follows:
- Glecaprevir plus pibrentasvir: 99% of patients achieved sustained virological response at 12 weeks 2
- Sofosbuvir/velpatasvir: 98% of patients achieved sustained virological response 12 weeks after treatment 3
- Ledipasvir and sofosbuvir: 96% of patients achieved sustained virological response 12 weeks after treatment 4
Safety of Antiviral Regimens
The safety of these regimens is as follows:
- Glecaprevir plus pibrentasvir: 69% of patients experienced adverse events, with the most common being fatigue and headache 2
- Sofosbuvir/velpatasvir: no patients discontinued treatment due to adverse events, with the most common adverse events being upper respiratory tract infection and headache 3
- Ledipasvir and sofosbuvir: one patient discontinued treatment due to an adverse event, with the most common adverse events being headache, fatigue, and asthenia 4
Real-World Evidence
Real-world evidence from a study published in Liver international : official journal of the International Association for the Study of the Liver showed that sofosbuvir/velpatasvir is highly effective and safe for treating patients with HCV genotypes 1-6 and advanced fibrosis or compensated cirrhosis, with 98.9% of patients achieving sustained virological response 12/24 weeks after treatment 5
Regional Efficacy
A study published in The lancet. Gastroenterology & hepatology demonstrated the efficacy and safety of sofosbuvir-velpatasvir in Asian patients with chronic HCV infection, with 97% of patients achieving sustained virological response 12 weeks after treatment 6