Improvements in hepatitis C treatment have introduced pan-genotypic treatments, which treat all HCV genotypes (virus strains) with one treatment, shorter treatment time averaging from 8 to 12 weeks for the majority of liver conditions with high cure rates of 95% to 100%.
Over the past several years we’ve seen the landscape of treatment for hepatitis C change. The majority of treatments can be used without ribavirin. Common treatment side effects are headache and fatigue, allowing more patients to work full time while taking treatment.
FDA-approved generic treatments are now available in the U.S. as well as less expensive treatments that have driven higher-cost treatments out of the market.
Determining Which Hepatitis C Treatment to Use
Deciding which hepatitis C treatment is best for each patient will be determined by several factors:
- Genotype (virus strain)
- Viral load
- Liver Condition
- Other medical conditions
- Medications the patient takes
- Any co-infections (Hep B, HIV, or co-infection with more than one genotype at the same time)
- associated liver conditions or liver transplant
- Treatment-naïve or Treatment experienced
The length of treatment will depend on; genotype, liver condition, viral load, and if any prior treatment history. See each treatment for information on side effects and other important information.
FDA-Approved Treatment for Hepatitis C As of 2021
Epclusa: fixed-dose of sofosbuvir/velpatasvir
For Genotypes: 1, 2, 3, 4, 5, and 6
Liver Condition: For patients without cirrhosis or with compensated cirrhosis. For patients with decompensated cirrhosis, ribavirin is used with Epclusa.
Dosage: 1 pill per day
Treatment Length: 12 weeks
Cure Rate: 98%
Common Side Effects: Headache and Fatigue
Note: Can be used with or without Ribavirin. U.S. FDA approved Generic available.
Mavyret: fixed-dose of gelcaprevir/pibrentasvir
For Genotypes: 1, 2, 3, 4, 5, and 6
Liver Condition: For patients without treatment experience without cirrhosis or with compensated cirrhosis. Can be used for Genotype 1 previously treated with NS5A inhibitor or NS3/4A protease inhibitor but not both.
Dosage: 3 pills, once per day at a set time. Take with food.
Treatment Length: 8, 12, or 16 weeks.
Cure Rate: 95%-100%
Common Side Effects: Headache, Fatigue
Note: Mavyret can also be used for children 12 years or older weighing at least 99 lbs.
Caution for Hep B reactivation.
Vosevi: fixed-dose of sofosbuvir/velpatasvir/voxilaprevi
For Genotypes: 1, 2, 3, 4, 5, and 6
Liver Condition: For those without cirrhosis, or with compensated cirrhosis. Also used for patients previously treated with advanced Hep C regimens
Dosage: 1 pill daily with food.
Treatment Length: 12 weeks
Cure Rates: 91%-100%
Common Treatment Side Effects: Headache, Fatigue, Diarrhea, Nausea
Note: Caution for Hep B reactivation
Harvoni: fixed-dose of ledipasvir/sovaldi
For Genotypes: 1, 4, 5, and 6
Liver Condition: For patients with or without compensated cirrhosis. Harvoni is used with ribavirin for genotype 1 with decompensated cirrhosis. Or for genotype 1 or 4 with or without compensated cirrhosis who have had a liver transplant.
Dosage: 1 pill per day
Treatment Length: 12 weeks
Cure Rate: 96%-99%
Common Treatment Side Effects: Headache and Fatigue
Note: Harvoni can be used for children. U.S. FDA-approved generic available. Harvoni and be used with or without ribavirin.
Caution for hepatitis B reactivation.
Zepatier: fixed-dose of elbasvir/grazoprevir
For Genotypes: 1, 4
Liver Condition: For genotype 1 with mutations resistant to treatment or genotype 4 previously treated
Dosage: 1 pill per day at a set time with or without food.
Treatment Length: 12 or 16 weeks
Cure rate: 94%-100%
Note: Zepatier can be used with or without ribavirin
Talk to your doctor about which treatment is best suited for you.
*See each medication for full treatment and caution information.
*All treatment options and medications have been reviewed and updated as of February 2021.
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This entry was originally published on Life Beyond Hepatitis C on March 31, 2021 and is reprinted with permission.
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