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Hepatitis C Genotype 1 Treatment

 HCV Virus



HCV Genotype

1A and 1B

Treatment and Cost

 

 

Medication by Genotype

Medication Cost by Drug and Regimen

In the United States, genotype 1 HCV is the most common infection, accounting for approximately 70 to 75% of all hepatitis C infections. Accordingly, treatment of genotype 1 has the most extensive data and highest clinical relevance for hepatitis C treatment issues in the United States. Genotype 1 infection has been historically difficult to treat, but multiple recent studies have shown SVR rates greater than 90% in these genotype 1 patients using well-tolerated, all-oral regimens consisting of new direct-acting antiviral agents. The use of these direct-acting antiviral agents has been complicated by the high price of therapy. For example, the cost of the preferred regimens in the 2014 AASLD/IDSA/IAS-USA Guidance for treatment of genotype 1 infection range from approximately $63,000 to $150,000 in patients without cirrhosis and $84,000 to $300,000 in those with cirrhosis (Figure 1). The following discussion regarding initial treatment and retreatment of patients with genotype 1a or 1b chronic hepatitis C assumes the patient and their clinician have already made the decision to initiate hepatitis C therapy.

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Genotype 1 Chronic HCV: Initial Treatment 
Treatment-Naive Patients with Genotype 1 Infection

Recommended regimen for retreatment of Genotype 1a without cirrhosis                         

Ledipasvir - Sofosbuvir

Fixed-dose

combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 12 weeks                 

Recommended regimen for retreatment of Genotype 1a without cirrhosis

Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir

Fixed-dosecombination of ombitasvir (12.5 mg)/paritaprevir (75 mg)/ritonavir (50 mg) two tablets once daily plus

+

Ribavirin

1000 mg if  ≥75 kg x 12 weeks  (no cirrhosis) or 24 weeks (cirrhosis)g

Genotype 1 Chronic HCV: Retreatment

Prior Treatment Failure (received Sofosbuvir-Containing Regimen)

 

 


Recommended regimens for patients without advanced   fibrosis

Rating: Class IIb, Level C

Note: Based on the limited data available for effective therapy, patients without an urgent need for

HCV treatment should defer antiviral therapy pending additional data or consider treatment within clinical trial settings

Recommended regimen for patients with advanced fibrosis

Ledipasvir-Sofosbuvir

Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 24 weeks 

± 

Ribavirin 1000 mg if or 1200 mg if ≥75 kg x 24 weeks

Genotype 1 Chronic HCV: Retreatment

Prior Treatment Failure (received Sofosbuvir-Containing Regimen)

Recommended regimens for patients without advanced fibrosis

Rating: Class IIb, Level C

Note: Based on the limited data available for effective therapy, patients without an urgent need for HCV treatment should defer antiviral therapy pending additional data or consider treatment within clinical trial settings.

Recommended regimen for patients with advanced fibrosis

Ledipasvir-Sofosbuvir

Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 24 weeks ± Ribavirin 1000 mg  

Rating: Class IIa, Level C

Note: The ribavirin daily dose is given in two divided doses.

Genotype 1 Chronic HCV: Retreatment

Prior Treatment Failure (received Peginterferon, Ribavirin, and HCV Protease Inhibitor)

Recommended regimen for patients without cirrhosis, regardless of genotype 1 subtype


Ledipasvir - Sofosbuvir

Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400  mg) once daily x 12 weeks

 

Genotype 1 Chronic HCV: Retreatment

Prior Treatment Failure (received Peginterferon, Ribavirin, and HCV

Protease Inhibitor)


Recommended regimen for patients with cirrhosis, regardless of genotype 1 subtype

Ledipasvir - Sofosbuvir

Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400  mg) once daily x 12 weeks

Recommended regimen for

Genotype 1a

Sofosbuvir

400 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)+

+

Simeprevir

150 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)

+

Ribavirin

1000 mg/day if

Rating: Class IIa, Level B

Note: The ribavirin daily dose is given in two divided doses

Recommended regimen for

Genotype 1b

Ledipasvir- Sofosbuvir

Fixed-dosecombination of ledipasvir (90 mg)/sofosbuvir (400 mg) one tablet once daily x 12 weeks*

Rating: Class I, Level A

Note: *In the ION-3 trial, patients without cirrhosis and a baseline HCV RNA levels less than 6 million IU/ml had similar relapse rates when treated with 8 weeks versus 12 weeks. Decreasing the length of the regimen to 8 weeks should be done with caution.

Recommended regimen for

Genotype 1b

Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir

Fixed-dose combination of ombitasvir (12.5 mg)/paritaprevir (75 mg)/ritonavir (50 mg) two tablets once daily plus dasabuvir (250 mg) one tablet twice daily x 12 weeks 

Ribavirin

For patients with cirrhosis, the addition of ribavirin (1000 mg/day if kg or 1200 mg/day if ≥75 kg x 12 weeks  is recommended

Rating: Class I, Level A

Note: The ribavirin daily dose is given in two divided doses.

Recommended regimen for

Genotype 1b

Sofosbuvir

400 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)

+

Simeprevir

150 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)

Rating: Class II, Level B


Hepatitis C Genotype 1 Treatment Cost 

 

Source: Hepatitis C Online