S46(1) HCV Pharmacologic Treatment

Question 1

NS3/4A Protease Inhibitors (-”previr”)

Answer 1

Grazoprevir
Glecaprevir
Voxilaprevir

Question 2

NS5B Inhibitors (“-buvir”)

Answer 2

Sofosbuvir

Question 3

NS5A Inhibitors (“asvir”)

Answer 3

Ledipasvir
Elbasvir
Velpatasvir
Pibrentasvir

Question 4

Sofosbuvir/ledipasvir (Harvoni®)

Answer 4

Genotypes Covered: 1, 4, 5 and 6

Question 5

Sofosbuvir/ledipasvir (Harvoni®)

Key Drug-Drug Interactions

Answer 5

Avoid: amiodarone, anticonvulsants (carbamazepine, oxcarbazepine, phenytoin, phenobarbital), rifamycins, St. Johns Wort, rosuvastatin

Question 6

Sofosbuvir/ledipasvir (Harvoni®)

Clinical Pearls

Answer 6

Affected by acid suppressors
PPIs: Take simultaneously fasting (do not exceed the equivalent of omeprazole 20 mg)
H2RAs: Take simultaneously and/or 12 hours apart
Antacids: Separate by 4 hours
Can increase the concentrations of statins

Question 7

Grazoprevir/elbasvir (Zepatier®)

Answer 7

Genotypes (GTs) Covered: 1 and 4

Question 8

Grazoprevir/elbasvir (Zepatier®)

Key Drug-Drug Interactions

Answer 8

Avoid: anticonvulsants (carbamazepine, oxcarbazepine, phenytoin, phenobarbital), rifamycins, St. Johns Wort, cyclosporine
Can increase the concentrations of statins

Question 9

Grazoprevir/elbasvir (Zepatier®)

Clinical Pearls

Answer 9

Requires resistance associated substitutions (RASs) testing for GT 1a

Question 10

Sofosbuvir/velpatasvir (Epclusa®)

Answer 10

Genotypes (GTs) Covered: 1-6

Question 11

Sofosbuvir/velpatasvir (Epclusa®)

Key Drug-Drug Interactions

Answer 11

Avoid: PPIs, amiodarone, anticonvulsants (carbamazepine, oxcarbazepine, phenytoin, phenobarbital), rifamycins, St. Johns Wort
Can increase the concentrations of statins

Question 12

Sofosbuvir/velpatasvir (Epclusa®)

Clinical Pearls

Answer 12

Affected by acid suppressors
PPIs: Avoid, can consider omeprazole 20 mg if medically necessary
H2RAs: Take simultaneously and/or 12 hours apart
Antacids: Separate by 4 hours

Question 13

Sofosbuvir/velpatasvir (Epclusa®)

Comorbid conditions

Answer 13

In GT3, resistance testing is recommended in those with cirrhosis or prior treatment with pegylated interferon and ribavirin

Question 14

Glecaprevir/pibrentasvir (Mavyret®)

Answer 14

Genotypes Covered: 1-6

Question 15

Glecaprevir/pibrentasvir (Mavyret®)

Key Drug-Drug Interactions

Answer 15

Avoid: anticonvulsants (carbamazepine, oxcarbazepine, phenytoin, phenobarbital), rifamycins, St. Johns Wort, > 100 mg of cyclosporine, ethinyl estradiol, atorvastatin, lovastatin, and simvastatin
Can increase the concentrations of statins

Question 16

Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®)

Answer 16

Genotypes Covered: 1-6
Mainly reserved for patients with prior DAA failures
(Salvage Therapy)

Question 17

Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®)

Key Drug-Drug Interactions

Answer 17

Avoid: PPIs, amiodarone, anticonvulsants (carbamazepine, oxcarbazepine, phenytoin, phenobarbital), rifamycins, St. Johns Wort, rosuvastatin, pitavastatin, cyclosporine
Can increase the concentrations of statins

Question 18

Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®)

Clinical Pearls

Answer 18

Affected by acid suppressors
PPIs: Avoid, can consider omeprazole 20 mg if medically necessary
H2RAs: Take simultaneously and/or 12 hours apart
Antacids: Separate by 4 hours

Question 19

Ribavirin (Copegus®)

Answer 19

Added to some DAA regimens to improve efficacy

Decompensated cirrhosis
Sofosbuvir/velpatasvir when used in genotype 3 patients with certain resistance with prior treatment history, as well as, cirrhotics with certain resistance
Some DAA experienced patients

Question 20

Ribavirin (Copegus®)

Adverse effects

Answer 20

Hemolytic anemia
Do not use in pregnancy
FDA pregnancy category X
Use 2 types of birth control while using this medication
Continue birth control for 6 months after stopping medication