Page 26 - EASL Recommendations on Treatment of Hepatitis C 2015 - Full version
P. 26
JOURNAL OF HEPATOLOGY
Table 7 (continued)
Failed treatment Genotype Sofosbuvir and Ritonavir-boosted Ritonavir-boosted Sofosbuvir and Sofosbuvir and daclatasvir
ledipasvir paritaprevir, paritaprevir, and simeprevir
ombitasvir and ombitasvir
dasabuvir
No
Sofosbuvir and Genotype 1 No No No 12 wk with RBV No
daclatasvir Genotype 2 No No or 24 wk with
No No RBV if F3 or 12 wk with RBV or 24 wk
or or 3 No No cirrhosis with RBV if F3 or cirrhosis
Genotype 4 No No
Sofosbuvir and No No No
ledipasvir Genotype 5 12 wk with RBV or No
or 6 24 wk with RBV if No 12 wk with RBV 12 wk with RBV or 24 wk
Ritonavir-boosted or 24 wk with with RBV if F3 or cirrhosis
paritaprevir, Genotype 1 F3 or cirrhosis RBV if F3 or
12 wk with RBV or cirrhosis 12 wk with RBV or 24 wk
ombitasvir and Genotype 4 24 wk with RBV if with RBV if F3 or cirrhosis
dasabuvir No
F3 or cirrhosis 12 wk with RBV or 24 wk
Ritonavir-boosted 12 wk with RBV with RBV if F3 or cirrhosis
paritaprevir and 12 wk with RBV or or 24 wk with
24 wk with RBV if RBV if F3 or
ombitasvir cirrhosis
F3 or cirrhosis
12 wk with RBV
or 24 wk with
RBV if F3 or
cirrhosis
Currently, there is limited data to firmly support these retreatment recommendations, which are based on indirect evidence and consideration of HCV genotype, known
resistance profiles of the previously administered drugs, number of drugs used, use of ribavirin, treatment duration. Thus, these recommendations are subject to change
when more data become available.
(genotype 1 or 4), sofosbuvir plus daclatasvir (all genotypes) or with a combination of sofosbuvir with daclatasvir or ledipasvir,
sofosbuvir plus ledipasvir (genotypes 1, 4, 5 or 6), with riton- whereas patients who failed on a regimen containing sofosbuvir
avir-boosted paritaprevir, ombitasvir and dasabuvir (genotype and daclatasvir or ledipasvir should be retreated with a com-
1), or with ritonavir-boosted paritaprevir and ombitasvir (geno- bination of sofosbuvir and simeprevir (genotype 1 and 4). The
type 4). In a study, retreatment with 12 weeks of sofosbuvir plus retreatment strategy is unclear for patients infected with geno-
ledipasvir with ribavirin yielded SVR in 98% (50/51) of genotype 1 types 2, 3, 5 or 6 who failed on a regimen containing sofosbuvir
patients who failed prior treatment with sofosbuvir plus placebo, and daclatasvir or ledipasvir; retreatment with the same option
may be proposed, provided that ribavirin is added and/or treat-
or sofosbuvir plus ribavirin, or sofosbuvir plus PegIFN-a and rib- ment duration is extended to 24 weeks.
avirin [87]. Patients who failed on the triple combination of ritonavir-
Genotype 1 and 4 patients who failed on a regimen combining boosted paritaprevir, ombitasvir and dasabuvir should be
retreated with a sofosbuvir-based regimen. The value and safety
PegIFN-a, ribavirin and simeprevir should be retreated with a of retreatment strategies combining three drugs, including sofos-
buvir, a protease inhibitor and an NS5A inhibitor, is unknown.
combination of sofosbuvir with daclatasvir or ledipasvir.
Patients without an urgent need for treatment can wait until
Patients who failed on a regimen combining PegIFN-a, ribavirin more data and/or alternative therapeutic options become
available.
and daclatasvir should be retreated with a combination of sofos-
buvir and simeprevir (genotype 1 and 4).
Patients infected with genotype 1 or 4 who failed on a regi-
men containing sofosbuvir and simeprevir should be retreated
25
Table 7 (continued)
Failed treatment Genotype Sofosbuvir and Ritonavir-boosted Ritonavir-boosted Sofosbuvir and Sofosbuvir and daclatasvir
ledipasvir paritaprevir, paritaprevir, and simeprevir
ombitasvir and ombitasvir
dasabuvir
No
Sofosbuvir and Genotype 1 No No No 12 wk with RBV No
daclatasvir Genotype 2 No No or 24 wk with
No No RBV if F3 or 12 wk with RBV or 24 wk
or or 3 No No cirrhosis with RBV if F3 or cirrhosis
Genotype 4 No No
Sofosbuvir and No No No
ledipasvir Genotype 5 12 wk with RBV or No
or 6 24 wk with RBV if No 12 wk with RBV 12 wk with RBV or 24 wk
Ritonavir-boosted or 24 wk with with RBV if F3 or cirrhosis
paritaprevir, Genotype 1 F3 or cirrhosis RBV if F3 or
12 wk with RBV or cirrhosis 12 wk with RBV or 24 wk
ombitasvir and Genotype 4 24 wk with RBV if with RBV if F3 or cirrhosis
dasabuvir No
F3 or cirrhosis 12 wk with RBV or 24 wk
Ritonavir-boosted 12 wk with RBV with RBV if F3 or cirrhosis
paritaprevir and 12 wk with RBV or or 24 wk with
24 wk with RBV if RBV if F3 or
ombitasvir cirrhosis
F3 or cirrhosis
12 wk with RBV
or 24 wk with
RBV if F3 or
cirrhosis
Currently, there is limited data to firmly support these retreatment recommendations, which are based on indirect evidence and consideration of HCV genotype, known
resistance profiles of the previously administered drugs, number of drugs used, use of ribavirin, treatment duration. Thus, these recommendations are subject to change
when more data become available.
(genotype 1 or 4), sofosbuvir plus daclatasvir (all genotypes) or with a combination of sofosbuvir with daclatasvir or ledipasvir,
sofosbuvir plus ledipasvir (genotypes 1, 4, 5 or 6), with riton- whereas patients who failed on a regimen containing sofosbuvir
avir-boosted paritaprevir, ombitasvir and dasabuvir (genotype and daclatasvir or ledipasvir should be retreated with a com-
1), or with ritonavir-boosted paritaprevir and ombitasvir (geno- bination of sofosbuvir and simeprevir (genotype 1 and 4). The
type 4). In a study, retreatment with 12 weeks of sofosbuvir plus retreatment strategy is unclear for patients infected with geno-
ledipasvir with ribavirin yielded SVR in 98% (50/51) of genotype 1 types 2, 3, 5 or 6 who failed on a regimen containing sofosbuvir
patients who failed prior treatment with sofosbuvir plus placebo, and daclatasvir or ledipasvir; retreatment with the same option
may be proposed, provided that ribavirin is added and/or treat-
or sofosbuvir plus ribavirin, or sofosbuvir plus PegIFN-a and rib- ment duration is extended to 24 weeks.
avirin [87]. Patients who failed on the triple combination of ritonavir-
Genotype 1 and 4 patients who failed on a regimen combining boosted paritaprevir, ombitasvir and dasabuvir should be
retreated with a sofosbuvir-based regimen. The value and safety
PegIFN-a, ribavirin and simeprevir should be retreated with a of retreatment strategies combining three drugs, including sofos-
buvir, a protease inhibitor and an NS5A inhibitor, is unknown.
combination of sofosbuvir with daclatasvir or ledipasvir.
Patients without an urgent need for treatment can wait until
Patients who failed on a regimen combining PegIFN-a, ribavirin more data and/or alternative therapeutic options become
available.
and daclatasvir should be retreated with a combination of sofos-
buvir and simeprevir (genotype 1 and 4).
Patients infected with genotype 1 or 4 who failed on a regi-
men containing sofosbuvir and simeprevir should be retreated
25
