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Hepatitis C Genotype 2 Treatment

 



HCV Genotype

2A and 2B

Treatment and Cost

 

 

Medication by Genotype

Medication Cost by Drug and Regimen

 

In the United States, genotype 2 accounts for approximately 13 to 15% of all hepatitis C infections. Given the historically relatively high sustained virologic response (SVR) rates with the treatment of genotype 2, the data regarding retreatment of patients with genotype 2 in whom prior therapy failed is somewhat limited. The following discussion regarding initial treatment and retreatment of patients with genotype 2 chronic hepatitis C assumes the patient and their clinician have already made the decision to proceed with hepatitis C therapy. The FDA approval of the newest, highly effective, well-tolerated direct-acting antiviral agents (DAAs) has been complicated by the high price of these new agents. For the regimens included as preferred or alternative in the 2014 AASLD/IDSA/IAS-USA Guidance for genotype 2 infection, the cost of the treatment regimens range from approximately $85,000 to $113,000 (Figure 1). Although company-related drug assistance programs provides free medication to some low-income patients, getting medications paid for remains problematic for many clinicians and patients.

Historically, treatment of genotype 2 infection achieved higher sustained virologic response (SVR) rates than with genotype 1 infection, even with a shorter duration of therapy and lower doses of ribavirin. Until recently, the standard of care for treatment-naive patients with genotype 2 hepatitis C has consisted of a 24-week course of peginterferon plus fixed-dose ribavirin, with SVR rates of 75 to 85%. In 2013, the FDA approved a 12-week course with the all-oral regimen of sofosbuvir plus ribavirin for the treatment of genotype 2 infection based on data from several studies showing SVR rates of approximately 95% with this regimen. The approval of this regimen represented a landmark introduction of interferon-free therapy for chronic hepatitis C. No hepatitis C protease inhibitors have received FDA approval for the treatment of genotype 2 HCV, but simeprevir has shown in vitro activity against HCV genotype 2.

Factors to Consider Prior to Choosing Treatment Regimen: For patients chronically infected with genotype 2 hepatitis C, two major factors determine the optimal treatment regimen and duration: (1) whether the patient has previously received and failed therapy and (2) the presence or absence of cirrhosis. Hepatitis C therapy in patients with decompensated cirrhosis, renal impairment,

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Genotype 2 Chronic HCV: Initial Treatment
Treatment-Naive Patients with Genotype 2 Infection

Recommended regimen for

Genotype 2 without cirrhosis

Sofosbuvir

400 mg once daily x 12 weeks

+

Ribavirin

Ribavirin

1000 mg if


Rating: Class I, Level A

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


Recommended regimen for

Genotype 2 with cirrhosis


Sofosbuvir

400 mg once daily x 16 weeks

+

Ribavirin

1000 mg if


Rating: Class IIb, Level C

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


Not recommended for Genotype 2

 

 


  • Peginterferon plus Ribavirin for 24 weeks
    Rating: Class IIb, Level A
  • Monotherapy with Peginterferon, Ribavirin, or a Direct-Acting Antiviral Rating: Class III, Level A
Telaprevir-, Boceprevir-, or Ledipasvir-containing regimens
Rating: Class III, Level A
 Genotype 2 Chronic HCV: Retreatment 

Recommended regimen for

Patients with Genotype 2 in whom prior Peginterferon and Ribavirin therapy failed


Sofosbuvir

400 mg once daily x 12 or 16 weeks

+

Ribavirin

1000 mg if

Rating: Class I, Level A

Note: (i) patients with cirrhosis may benefit by extension of therapy to 16 weeks; the decision to extend therapy should be made on a case-by-case basis, (ii) the ribavirin daily dose is given in two divided doses

Alternative regimen for

Patients with Genotype 2 who are eligible to receive interferon and in whom prior Peginterferon and Ribavirin therapy failed

Sofosbuvir

400 mg once daily x 12 weeks

+

Ribavirin

1000 mg if

+

Peginterferon alfa-2a

180 mcg subcutaneously once weekly x 12 weeks

OR

Peginterferon alfa-2b

1.5 mcg/kg subcutaneously once weekly x 12 weeks


 

Not recommended for retreatment of genotype 2 patients in whom prior Peginterferon and Ribavirin therapy failed

 
  • Peginterferon plus Ribavirin with or without Telaprevir or Boceprevir Rating: Class IIb, Level A
  • Fixed-dose combination Ledipasvir-Sofosbuvir Rating: Class III, Level A
  • Monotherapy with Peginterferon, Ribavirin, or a Direct-Acting Antiviral Rating: Class III, Level A


Source: Hepatitis C Online


Hepatitis C Genotype 2 Treatment Cost