Which medications in the drug class Direct-acting antiviral drugs are used in the treatment of Pediatric 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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Answer

Direct-acting antiviral drugs

Direct-acting antiviral (DAA) drugs interfere with specific steps in the HCV replication cycle through a direct interaction with the HCV genome, polyprotein, or its polyprotein cleavage products.

Sofosbuvir (Sovaldi)

Sofosbuvir is a nucleotide prodrug that undergoes metabolism to the active uridine analog triphosphate, an inhibitor of HCV NS5B RNA-dependent polymerase; its inhibition in turn suppresses viral replication. It is indicated for the treatment of chronic HCV genotypes 2 or 3 infection in pediatric patients aged ≥12 y or weighing at least 35 kg without cirrhosis or with compensated cirrhosis. It is used in combination with ribavirin.

Ledipasvir/sofosbuvir (Harvoni)

Ledipasvir inhibitors HCV NS5A protein, which is required for viral replication. Sofosbuvir is a nucleotide prodrug that undergoes metabolism to the active uridine analog triphosphate, an inhibitor of HCV NS5B RNA-dependent polymerase; its inhibition in turn suppresses viral replication. The combination is indicated for pediatric patients aged ≥12 y or weighing at least 35 kg with hepatitis C virus (HCV) genotype 1, 4, 5, or 6 infection without cirrhosis or with compensated cirrhosis.

Glecaprevir/pibrentasvir (Mavyret)

Glecaprevir is a HCV NS3/4A protease inhibitor. NS3/4A protease is necessary for 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. Pibrentasvir is a HCV NS5A inhibitor. NS5A is essential for viral RNA replication and virion assembly.

Glecaprevir/pibrentasvir is indicated for treatment-naïve adolescents who are 12-17 y old or weigh at least 45 kg (99 lb) with chronic hepatitis C virus (HCV) genotypes 1-6 without cirrhosis or with compensated cirrhosis. It is also indicated for treatment-experienced adolescents with HCV genotype 1 who have been previously treated with a regimen containing either an NS5A inhibitor or an NS3/4A protease inhibitor, 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.


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