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Hepatitis C
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Rebecca Pierce-Williams, Neil Silverman, Raja Dhanekula, Jonathan M. Fenkel, Danielle Tholey
Historically, treatment consisted of pegylated interferon (PEG-IFN), ribavirin and protease inhibitors. Ribavirin is contraindicated in pregnancy due to teratogenicity concerns. Treatment has changed dramatically since 2011 with the development of DAAs.For any genotype, in a treatment-naïve patient without cirrhosis, the preferred therapy is either 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir.Treatments are associated with few and mild side effects (headache, nausea, fatigue, insomnia).Ongoing research into HCV treatment (ledipasvir/sofosbuvir) during pregnancy is promising, as many women could be cured while receiving prenatal care.Until treatment in pregnancy is approved, women should be referred to a hepatologist in the postpartum treatment for antiviral therapy and long-term follow-up.
Investigational Antiviral Drugs
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
John Mills, Suzanne M. Crowe, Marianne Martinello
Pibrentasvir (ABT-530) is an orally administered NS5A assembly inhibitor. See section 3a, Glecaprevir (Kwo et al., 2016a; Kwo et al., 2016b; Lawitz et al., 2015; Poordad et al., 2016a; Poordad et al., 2016b).
Direct antiviral agents (DAAs) and their use in pregnant women with hepatitis C (HCV)
Published in Expert Review of Anti-infective Therapy, 2022
Sandra Abdul Massih, Ahizechukwu C. Eke
are both potent, pan-genotypic (HCV genotypes 1–6) combination of a NS3/4A protease inhibitor (GLE) and an NS5A inhibitor (PIB) [40]. Glecaprevir/Pibrentasvir is manufactured as a fixed-dose combination of 100 mg/40 mg tablet of GLE and PIB, respectively, and is dosed in a single administration per day (three tablets) [40]. This fixed-drug combination was FDA approved in 2019 for treatment of HCV, as this drug combination was noted to be effective against HCV genotypes 1–6 [40]. As a combination of a NS3/4A protease inhibitor and an NS5A inhibitor, GLE/PIB inhibits the viral replication and virion assembly [40]. Glecaprevir/Pibrentasvir is absorbed well orally when dosed with meals, with an 83–163% increase in absorption for GLE following a meal, compared with only 40–53% increase for PIB. The oral bioavailability of GLE/PIB is approximately 90% in humans, with a protein-binding of >97% [40]. Following an oral dose of GLE/PIB, drug concentrations are widely distributed, with the highest concentrations found in the liver. The Tmax is approximately 5 hours, with an elimination half-life of 6 and 13 hours for GLE and PIB, respectively. This might be related to the fact that, while both are primarily eliminated through the biliary-fecal route (with minimal renal excretion), GLE is secondarily metabolized by CYP3A4/5, while PIB is not [40].
Direct acting antivirals for the treatment of hepatitis C in ethnic minority populations
Published in Expert Opinion on Pharmacotherapy, 2018
The second generation of DAAs initially entailed sofosbuvir and simeprevir [21,22]. The results of early clinical trials with these medications, especially sofosbuvir [23,24], resulted in the paradigm shift away from both IFN and RBV for treatment of the most common type of HCV in the United States (genotype 1). Currently there are multiple new regimens for HCV arriving with high SVR rates and even shorter regimens (see Table 1). A review of current American Association for the Study of Liver Disease/Infectious Disease Society of America (AASLD/IDSA) guidelines for hepatitis C treatment shows a focus on four therapies for HCV: Elbasvir/Grazoprevir, Ledipasvir/Sofosbuvir, Velpatasvir/Sofosbuvir, and Glecaprevir/Pibrentasvir [25] (see Table 1). Within this review we will focus on the recommended AASLD/IDSA regimens for treatment of HCV in the DAA era as it relates to racial/ethnic populations.
Treatment of hepatitis C virus infection for adults and children: updated Swedish consensus guidelines 2017
Published in Infectious Diseases, 2018
Martin Lagging, Rune Wejstål, Ann-Sofi Duberg, Soo Aleman, Ola Weiland, Johan Westin
Glecaprevir/pibrentasvir 8 weeks (16 weeks may be considered for patients having relapsed after interferon-based therapy (recommendation grade B2)).Sofosbuvir + daclatasvir 12 weeks [55].Sofosbuvir/velpatasvir 12 weeks [43,54].Sofosbuvir/velpatasvir/voxilaprevir for 8 weeks is approved, but it is the opinion of the consensus group that this triple combination should primarily be used for retreatment of patients having relapsed after DAA therapy [46].