Which medications are used to treat hepatitis C?

Updated: May 10, 2019
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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The first direct-acting antiviral drugs were approved for adolescents in 2017. Sofosbuvir (Sovaldi) and the combination product, ledipasvir/sofosbuvir (Harvoni), are approved for chronic HCV infection in pediatric patients aged ≥12 years or who weigh at least 35 kg.

Sofosbuvir is indicated for HCV genotypes 2 or 3 and is used in combination with ribavirin. An open-label study was conducted in adolescents (n=52) who received sofosbuvir 400 mg once daily and weight-based ribavirin twice daily for 12 (genotype 2) or 24 (genotype 3) weeks. Sustained virologic response at 12 weeks (SVR12) was achieved by 98% of patients (51/52; 95% confidence interval, 90%-100%). SVR12 rates were 100% (13/13) for patients with genotype 2 and 97% (38/39) for those with genotype 3. The single patient who did not achieve SVR12 was lost to follow-up after achieving SVR4. [9]

Ledipasvir/sofosbuvir is indicated for HCV genotypes 1, 4, 5, or 6. In an open-label study of adolescents (n=100) with HCV genotype 1, SVR12 was reached in 98%. The 2 patients who did not achieve sustained virologic response at 12 weeks were lost to follow-up either during or after treatment. [10] The safety and efficacy of ledipasvir/sofosbuvir for treatment of HCV genotypes 4, 5, or 6 infection in adolescents was based on data showing similar systemic exposures to ledipasvir/sofosbuvir in adults and adolescents with HCV genotype 1 infection, as well as similar efficacy and exposures across HCV genotypes 1, 4, 5, and 6 in adult. [11]

Alpha interferon (IFN) results in a sustained response in fewer than 20% of patients, and adverse effects are often problematic. More recently, the addition of oral ribavirin to IFN therapy has improved the sustained response rate to 40-50%. Some research suggests that the dose of interferon might be lowered in genotypes 2 and 3, if ribavirin is used in combination. However, adverse effects remain a problem, and the response rate is lower for individuals infected with genotype 1, the most common genotype that causes infection, and the less common genotype 4.

For patients with HCV genotype 1 who do not have a sustained response to therapy with peginterferon–ribavirin, a new treatment option is emerging. Though its role in pediatric HCV needs to be further defined, studies show that the potent oral HCV-protease inhibitor boceprevir is an effective treatment option for previously treated patients as well as untreated patients when used in addition to standard therapy as compared to standard therapy alone.

Pegylated IFN (the addition of polyethylene glycol to the drug) results in significantly higher rates of response, especially with non–genotype 1 hepatitis C virus (HCV) infections.

Peginterferon alfa-2b (PEG Intron) plus ribavirin (Rebetol) is approved for children aged 3 years or older, whereas peginterferon alfa-2a (Pegasys) plus ribavirin (Copegus) is approved for children aged 5 years or older.

One long-term study found that peginterferon was associated with significantly lower height, weight and BMI, which largely recovered when therapy was discontinued. However, height remained significantly lower for age in children treated for 48 weeks or more. [13]

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