Page 7 - EASL Recommendations on Treatment of Hepatitis C 2015 - Summary
P. 7
Genotype 1, IFN-free Option 4 Treatment of HCV genotype 3 infection
Three treatment options are available for patients infected
with HCV genotype 3. The combination of sofosbuvir and
ribavirin is suboptimal, in particular in patients with cirrhosis
• Patients infected with HCV genotype 1 can be treated who have previously failed IFN and ribavirin. Based on
with an IFN-free combination of daily sofosbuvir (400 data with other genotypes and results in a small group
mg) and daily daclatasvir (60 mg) for 12 weeks (A1) of genotype 3-infected patients, the triple combination of
PegIFN-α, ribavirin and sofosbuvir appears to be valuable.
• Based on data with other IFN-free combinations, The IFN-free combination of sofosbuvir and daclatasvir,
adding daily weight-based ribavirin (1000 or 1200 with or without ribavirin, is another attractive option for
mg in patients <75 kg or ≥75 kg, respectively) is patients infected with HCV genotype 3.
recommended in patients with cirrhosis (B1) Ledipasvir is considerably less potent against genotype 3
than daclatasvir in vitro; in clinical trials with ledipasvir, the
• In patients with cirrhosis with contra-indications to the respective roles of ledipasvir and ribavirin in combination
use of ribavirin, extending duration of treatment to 24 with sofosbuvir cannot be determined in the absence of
weeks must be considered (B1) control arms with sofosbuvir and ribavirin alone. Thus,
although this combination has been used, pending further
Treatment of HCV genotype 2 infection studies in larger populations including appropriate control
arms the combination of sofosbuvir plus ledipasvir is not
The best first-line treatment option for patients infected with recommended in patients infected with HCV genotype 3.
HCV genotype 2 is the IFN-free combination of sofosbuvir In settings where none of these options is available, the
and ribavirin. Other options may be useful in the small combination opfrePveigoIuFsNE-αASanLdCrliibnaicvairlinPrreamctiaciensGaucicdeeplintaebsl.e,
number of patients who fail on this regimen. In settings according to
where these options are not available, the combination of
PegIFN-α and ribavirin remains acceptable, according to Genotype 3, Option 1
previously published EASL Clinical Practice Guidelines.
Genotype 2, Option 1 • Patients infected with HCV genotype 3 can be treated
with a combination of weekly PegIFN-α, daily weight-
• Patients infected with HCV genotype 2 must be treated based ribavirin (1000 or 1200 mg in patients <75 kg or
with daily weight-based ribavirin (1000 or 1200 mg ≥75 kg, respectively), and daily sofosbuvir (400 mg) 12
in patients <75 kg or ≥75 kg, respectively), and daily weeks (B1)
sofosbuvir (400 mg) for 12 weeks (A1)
• This combination is a valuable option in patients who
• Therapy should be prolonged to 16 or 20 weeks in failed to achieve an SVR after sofosbuvir plus ribavirin
patients with cirrhosis, especially if they are treatment- treatment (B1)
experienced (B1)
Genotype 3, Option 2
Genotype 2, Option 2 • Patients infected with HCV genotype 3 can be treated
with daily weight-based ribavirin (1000 or 1200 mg
• Cirrhotic and/or treatment-experienced patients can in patients <75 kg or ≥75 kg, respectively), and daily
be treated with weekly PegIFN-α, daily weight-based sofosbuvir (400 mg) for 24 weeks (A1)
ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg,
respectively), and daily sofosbuvir (400 mg) 12 weeks • This therapy is suboptimal in treatment-experienced
(B1) cirrhotic patients and in patients who failed to achieve
an SVR after sofosbuvir plus ribavirin treatment, who
Genotype 2, Option 3 should be offered an alternative treatment option (B1)
• Cirrhotic and/or treatment-experienced patients can be
treated with an IFN-free combination of daily sofosbuvir
(400 mg) and daily daclatasvir (60 mg) for 12 weeks
(B1)
6
Three treatment options are available for patients infected
with HCV genotype 3. The combination of sofosbuvir and
ribavirin is suboptimal, in particular in patients with cirrhosis
• Patients infected with HCV genotype 1 can be treated who have previously failed IFN and ribavirin. Based on
with an IFN-free combination of daily sofosbuvir (400 data with other genotypes and results in a small group
mg) and daily daclatasvir (60 mg) for 12 weeks (A1) of genotype 3-infected patients, the triple combination of
PegIFN-α, ribavirin and sofosbuvir appears to be valuable.
• Based on data with other IFN-free combinations, The IFN-free combination of sofosbuvir and daclatasvir,
adding daily weight-based ribavirin (1000 or 1200 with or without ribavirin, is another attractive option for
mg in patients <75 kg or ≥75 kg, respectively) is patients infected with HCV genotype 3.
recommended in patients with cirrhosis (B1) Ledipasvir is considerably less potent against genotype 3
than daclatasvir in vitro; in clinical trials with ledipasvir, the
• In patients with cirrhosis with contra-indications to the respective roles of ledipasvir and ribavirin in combination
use of ribavirin, extending duration of treatment to 24 with sofosbuvir cannot be determined in the absence of
weeks must be considered (B1) control arms with sofosbuvir and ribavirin alone. Thus,
although this combination has been used, pending further
Treatment of HCV genotype 2 infection studies in larger populations including appropriate control
arms the combination of sofosbuvir plus ledipasvir is not
The best first-line treatment option for patients infected with recommended in patients infected with HCV genotype 3.
HCV genotype 2 is the IFN-free combination of sofosbuvir In settings where none of these options is available, the
and ribavirin. Other options may be useful in the small combination opfrePveigoIuFsNE-αASanLdCrliibnaicvairlinPrreamctiaciensGaucicdeeplintaebsl.e,
number of patients who fail on this regimen. In settings according to
where these options are not available, the combination of
PegIFN-α and ribavirin remains acceptable, according to Genotype 3, Option 1
previously published EASL Clinical Practice Guidelines.
Genotype 2, Option 1 • Patients infected with HCV genotype 3 can be treated
with a combination of weekly PegIFN-α, daily weight-
• Patients infected with HCV genotype 2 must be treated based ribavirin (1000 or 1200 mg in patients <75 kg or
with daily weight-based ribavirin (1000 or 1200 mg ≥75 kg, respectively), and daily sofosbuvir (400 mg) 12
in patients <75 kg or ≥75 kg, respectively), and daily weeks (B1)
sofosbuvir (400 mg) for 12 weeks (A1)
• This combination is a valuable option in patients who
• Therapy should be prolonged to 16 or 20 weeks in failed to achieve an SVR after sofosbuvir plus ribavirin
patients with cirrhosis, especially if they are treatment- treatment (B1)
experienced (B1)
Genotype 3, Option 2
Genotype 2, Option 2 • Patients infected with HCV genotype 3 can be treated
with daily weight-based ribavirin (1000 or 1200 mg
• Cirrhotic and/or treatment-experienced patients can in patients <75 kg or ≥75 kg, respectively), and daily
be treated with weekly PegIFN-α, daily weight-based sofosbuvir (400 mg) for 24 weeks (A1)
ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg,
respectively), and daily sofosbuvir (400 mg) 12 weeks • This therapy is suboptimal in treatment-experienced
(B1) cirrhotic patients and in patients who failed to achieve
an SVR after sofosbuvir plus ribavirin treatment, who
Genotype 2, Option 3 should be offered an alternative treatment option (B1)
• Cirrhotic and/or treatment-experienced patients can be
treated with an IFN-free combination of daily sofosbuvir
(400 mg) and daily daclatasvir (60 mg) for 12 weeks
(B1)
6
