Which medications in the drug class Combination Products are used in the treatment of Hepatitis C?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Answer

Combination Products

Several combination products have been approved and additional ones are being investigated to provide all oral regimens with high degrees of efficacy.

Ledipasvir/sofosbuvir (Harvoni)

Ledipasvir inhibits HCV NS5A protein, which is required for viral replication. Sofosbuvir is an inhibitor of HCV NS5B RNA-dependent polymerase. The oral combination is indicated for treatment of adults with chronic hepatitis C infection with genotype 1, 4, 5, or 6. Duration of therapy ranges from 8 to 24 weeks and depends on if the patient is treatment-naïve or experienced, and if cirrhosis is evident.

Ombitasvir/paritaprevir/ritonavir & dasabuvir (Viekira Pak)

This product is indicated for the treatment of chronic HCV genotype 1 infection, including patients with compensated cirrhosis; may be used for patients with HCV/HIV-1 coinfection. It is used in combination with ribavirin in certain patient populations (ie, genotype 1a, with or without cirrhosis; genotype 1b, with cirrhosis). Ombitasvir inhibits HCV NS5A, which is required for viral replication. Paritaprevir is a NS3/4A serine protease inhibitor. NS3/4A protease is needed for proteolytic cleavage of the HCV-encoded polyprotein into mature forms. Ritonavir is a protease inhibitor that is used as a "boosting agent" to increase paritaprevir serum levels. Dasabuvir is a nonnucleoside NS5B RNA-dependent polymerase inhibitor. It's inhibition, in turn, suppresses viral replication.

Ombitasvir/paritaprevir/ritonavir (Technivie)

Ombitasvir/paritaprevir/ritonavir is indicated in combination with ribavirin for genotype 4 chronic HCV infection without cirrhosis. Ombitasvir inhibits HCV NS5A, which is required for viral replication. Paritaprevir is a NS3/4A serine protease inhibitor. NS3/4A protease is needed for proteolytic cleavage of the HCV-encoded polyprotein into mature forms. Ritonavir is a protease inhibitor that is used as a "boosting agent" to increase paritaprevir serum levels.

Elbasvir/grazoprevir (Zepatier)

Elbasvir is an inhibitor of HCV NS5A, which is essential for viral RNA replication and virion assembly. Grazoprevir is an inhibitor of HCV NS3/4A protease, which is necessary for the proteolytic cleavage of the HCV-encoded polyprotein (into mature forms of the NS3, NS4A, NS4B, NS5A, and NS5B proteins) and is essential for viral replication. It is indicated with or without ribavirin for the treatment of adults with chronic HCV genotypes 1 or 4 infection.

Glecaprevir/pibrentasvir (Mavyret)

Combination of glecaprevir (NS3/4A protease inhibitor) and pibrentasvir (NS5A inhibitor). Glecaprevir/pibrentasvir is indicated in treatment-naïve patients aged 12 years and older or weighing at least 45 kg with chronic hepatitis C virus (HCV) genotype 1, 2, 3, 4, 5 or 6 infection without cirrhosis or with compensated cirrhosis (Child-Pugh A). It also is indicated in patients aged 12 years and older or weighing at least 45 kg with HCV genotype 1 infection, who previously have been treated with a regimen containing an HCV NS5A inhibitor or an NS3/4A protease inhibitor (PI), but not both. An 8-week regimen is approved for treatment-naïve patients with any genotype and for treatment-experienced patients with genotypes 1, 2, 4, 5, or 6 who had prior treatment with peginterferon, ribavirin, and/or sofosbuvir.

Sofosbuvir/velpatasvir (Epclusa)

Combination of sofosbuvir (NS5B RNA-dependent polymerase) and velpatasvir (pangenotypic NS5A inhibitor). It is indicated for adults with chronic hepatitis C virus (HCV) infection genotypes 1, 2, 3, 4, 5, or 6.

Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)

Combination of sofosbuvir (NS5B RNA-dependent polymerase), velpatasvir (pangenotypic NS5A inhibitor), and voxilaprevir (pangenotypic NS3/4A protease inhibitor). It is indicated for retreatment of chronic hepatitis C virus (HCV) infection in adults with genotype 1, 2, 3, 4, 5, or 6 previously treated with an NS5A inhibitor-containing regimen, or with genotype 1a or 3 previously treated with a sofosbuvir-containing regimen without an NS5A inhibitor.


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