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Sofosbuvir-based therapy changed expectations in HCV treatment, providing the chance for a cure to a broad range of patientsa

aSVR12 is defined as undetectable HCV RNA at 12 weeks after the end of treatment.1-3 Achieving SVR is considered a virologic cure.4



HARVONI Logo

HARVONI is indicated for the treatment of adults with chronic hepatitis C virus (HCV) genotype (GT) 1, 4, 5, or 6 infection without cirrhosis or with compensated cirrhosis. HARVONI is used with ribavirin in GT 1 adults with decompensated cirrhosis and in GT 1 or 4 adult liver transplant recipients without cirrhosis or with compensated cirrhosis.

EPCLUSA Logo

EPCLUSA is indicated for the treatment of adults with chronic HCV GT 1, 2, 3, 4, 5, or 6 infection without cirrhosis or with compensated cirrhosis and in combination with ribavirin for those with decompensated cirrhosis.

VOSEVI Logo

VOSEVI is indicated for the treatment of adults with chronic HCV infection without cirrhosis or with compensated cirrhosis who have GT 1, 2, 3, 4, 5, or 6 and were previously treated with an NS5A inhibitor, or who have GT 1a or 3 and were previously treated with sofosbuvir without an NS5A inhibitor (additional benefit of VOSEVI over sofosbuvir/velpatasvir was not shown in adults with GT 1b, 2, 4, 5, or 6 in this population).

IMPORTANT SAFETY INFORMATION FOR HARVONI, EPCLUSA, AND VOSEVI

BOXED WARNING: RISK OF HEPATITIS B VIRUS REACTIVATION IN HCV/HBV COINFECTED PATIENTS

Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with HARVONI, EPCLUSA, or VOSEVI. HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals (DAAs) and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death. Cases have been reported in patients who are HBsAg positive, in patients with serologic evidence of resolved HBV, and also in patients receiving certain immunosuppressant or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV DAAs may be increased in patients taking these other agents. Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated.

Contraindications

  • HARVONI and EPCLUSA: When used in combination with ribavirin (RBV), all contraindications, warnings and precautions, in particular pregnancy avoidance, and adverse reactions to RBV also apply. Refer to RBV prescribing information.
  • VOSEVI is contraindicated with rifampin.

Warnings and Precautions

  • Serious Symptomatic Bradycardia When Coadministered with Amiodarone: Amiodarone is not recommended for use with HARVONI, EPCLUSA, or VOSEVI due to the risk of symptomatic bradycardia, particularly in patients also taking beta blockers or with underlying cardiac comorbidities and/or with advanced liver disease. A fatal cardiac arrest was reported in a patient taking amiodarone who was coadministered a sofosbuvir containing regimen. In patients without alternative, viable treatment options, cardiac monitoring is recommended. Patients should seek immediate medical evaluation if they develop signs or symptoms of bradycardia.
  • Risk of Reduced Therapeutic Effect Due to Use with P-gp Inducers and/or Moderate to Potent Inducers of CYP: Rifampin, St. John’s wort and carbamazepine are not recommended for use with HARVONI, EPCLUSA, or VOSEVI. P-gp inducers may significantly decrease ledipasvir, sofosbuvir, velpatasvir, and/or voxilaprevir plasma concentrations. Moderate to potent inducers of CYP2B6, CYP2C8 or CYP3A4 may significantly decrease sofosbuvir, velpatasvir, and/or voxilaprevir plasma concentrations.

Adverse Reactions

  • The most common adverse reactions (≥10%, all grades) with HARVONI were fatigue, headache, and asthenia.
  • The most common adverse reactions (≥10%, all grades) with EPCLUSA were headache and fatigue; and when used with RBV in decompensated cirrhotics were fatigue, anemia, nausea, headache, insomnia, and diarrhea.
  • The most common adverse reactions (≥10%, all grades) with VOSEVI were headache, fatigue, diarrhea, and nausea.

Drug Interactions

  • HARVONI: Coadministration is not recommended with oxcarbazepine, phenobarbital, phenytoin, rifabutin, rifapentine, and tipranavir/ritonavir due to decreased concentrations of ledipasvir and sofosbuvir; or with co-formulated elvitegravir/‌cobicistat/‌emtricitabine/‌tenofovir disoproxil fumarate due to increased concentrations of tenofovir; or with simeprevir due to increased concentrations of ledipasvir and simeprevir; or with rosuvastatin due to increased concentrations of rosuvastatin.
  • EPCLUSA: Coadministration is not recommended with topotecan due to increased concentrations of topotecan; or with proton-pump inhibitors, oxcarbazepine, phenobarbital, phenytoin, rifabutin, rifapentine, efavirenz, and tipranavir/ritonavir due to decreased concentrations of sofosbuvir and/or velpatasvir.
  • VOSEVI: Coadministration is not recommended with phenytoin, phenobarbital, oxcarbazepine, rifabutin, rifapentine, atazanavir, lopinavir, tipranavir/ritonavir, efavirenz, rosuvastatin, pitavastatin, and cyclosporine due to changes (decreased or increased) in concentrations of sofosbuvir, velpatasvir, voxilaprevir, and/or the other agent.

Consult the full Prescribing Information for HARVONI, EPCLUSA, or VOSEVI for more information on potentially significant drug interactions, including clinical comments.

Please clicktap for full Prescribing Information for HARVONI, EPCLUSA, and VOSEVI, including BOXED WARNING.

References:

  1. HARVONI US full Prescribing Information. Gilead Sciences, Inc. Foster City, CA. April 2017.
  2. EPCLUSA US full Prescribing Information. Gilead Sciences, Inc. Foster City, CA. August 2017.
  3. VOSEVI US full Prescribing Information. Gilead Sciences, Inc. Foster City, CA. July 2017.
  4. US Department of Health and Human Services, Center for Drug Evaluation and Research. Draft Guidance for Industry. Chronic Hepatitis C Virus Infection: Developing Direct-Acting Antiviral Drugs for Treatment. May 2016.
TAP FOR IMPORTANT SAFETY
INFORMATION, including BOXED
WARNING on Hepatitis B reactivation.