Hepatitis treatments

What antivirals are used for Hepatitis B?

Lamivudine, Adefovir, Entecavir, Alpha interferon 2A/B

What is the MOA for Lamivudine

Inhibits HBV reverse transcription

What are the ADRS of Lamivudine

Minimal ADRs

What is the MOA for Adefovir

Inhibits HBV reverse transcriptase

What are the ADRs associated with Adefovir?

Proteinuria, increase SCr

What is the MOA for Entecavir

potent selective inhibitor of HBV polymerase

What are the ADRS of Entecavir?

HA, fatigue, muscle pain

What is the MOA for Alpha- Interferon 2a/2b

inhibits RNA transcription

What is the ADRs for Alpha interferon?

Vision changes, palpations, breathing problems

What medications should not be used for Hep B?

Truvada (tenofovir disoproxil fumarate and emtricitabine)

Emtriva (emtricitabine)

Viread (tenofovir disoproxil fumarate)

Note: These are used for HIV prevention 

What antivirals are used for Hep C?

• Glecaprevir/Pibrentasvir → Mavyret

• Sofosbuvir/Velpatasvir → Epclusa

• Ledipasvir/Sofosbuvir → Harvoni

• Ribavirin → Copegus

• Sofosbuvir/Velpatasvir/Voxilaprevir → Vosevi

What are the categories of Hep C treatments?

Someone who has not received Hep C treatment before

Failed previous therapy with PEG-IFN (Pegylated Interferon) plus RBV (Ribavirin)

Patients who have failed previous therapy with Sofosbuvir or Elbasvir/Grazoprevir

What is there to know about treating someone who has not received Hep C treatment before?

There is a preferred and alternative pathway:

• Preferred is organized into two subgroups based on genotype of Hep C virus

  • Group 1: Genotypes 1a, 1b, 2, 4;

  • Group 2: Genotype 3

• Alternative is organized into subgroups based on race, whether patient is HIV+ or HCV RNA is greater than 6 million copies, and genotype

  • Group 1: Genotype 1a or 1b (non-Black, HIV-negative, HCV RNA < 6 mil copies/mL)

  • Genotype 1a or 1b (Black, HIV-positive, or HCV RNA > 6 mil copies/mL) → Ledipasvir 90 mg / Sofosbuvir 400 mg

  • Genotypes 4, 5, 6

preferred treatment for Hep C patient who is treatment naive

Alternative treatment for Hep C patients who are treatment naive

What is there to know about treating someone who failed previous therapy with PEG-IFN + RBV?

There is a preferred and alternative pathway

• Preferred is organized into groups based on Genotype

  • Group 1: 1a, 1b, 2, 4, 5, 6

  • Group 2: 3

• Alternative is organized as well based on genotype

  • Group 1: 1a, 1b

  • group 2: 4, 5, 6

What is the preferred treatment for someone who failed previous therapy with PEG-IFN + RBV?

What is the alternative treatment who failed previous therapy with PEG-IFN + RBV?

What is there to know about treating someone with Hep C who had previous therapy with Sofosbuvir or Elbasvir/Grazoprevir?

Organized based on genotype

• Group 1: 1a, 1b, 2, 4, 5, 6

• group 2: genotype 3

How to treat someone with HEP C who had previous therapy with Sofosbuvir or Elbasvir/Grazoprevir?

Brand name of Glecaprevir/pibrentasvir

Mavyre

ADRs for Glecaprevir/pibrentasvir

Headache and fatigue

Brand name of Sofosbuvir/velpatasvir

Epclusa

ADRs for Sofosbuvir/velpatasvir

by itself→ headache and fatigue

when taken with ribavirin in patients with decompensated cirrhosis—> it causes the above symptoms + anemia, nausea, insomnia, and diarrhea

Brand name for Ledipasvir/sofosbuvir

Harvoni

ADRS of Ledipasvir/sofosbuvir

Asthenia, headache, and fatigue

Brand name of Ribavirin

Copegus

ADRs of Ribavirin

Fatigue/asthenia, pyrexia, myalgia, and headache in adults receiving combination therapy

Brand name of Sofosbuvir/velpatasvir/voxilaprevir

Vosevi

ADRs of Sofosbuvir/velpatasvir/voxilaprevir

Headache, fatigue, diarrhea, and nausea