Hepatitis C Treatment The goal of treatment for hepatitis C virus (HCV) is to cure the virus, which can be done with a combination of drugs. The specific meds used and the duration of treatment depend on a number of factors, including HCV genotype (genetic structure of the virus), viral load, past treatment experience, degree of liver damage, ability to tolerate the prescribed treatment, and whether the person is waiting for a liver transplant or is a transplant recipient. In some cases, HCV treatment may be limited by your health insurance plan or drug formulary. Here’s information about each type, or class, of approved HCV treatment along with drugs in the late stages of development: Multi-Class Combination Drugs Brand Name Generic Name Status Pharmaceutical Company Epclusa* sofosbuvir + velpatasvir Approved Gilead Sciences Harvoni* ledipasvir + sofosbuvir Approved Gilead Sciences Mavyret glecaprevir + pibrentasvir Approved AbbVie Vosevi sofosbuvir/velpatasvir/ voxilaprevir Approved Gilead Sciences Zepatier elbasvir + grazoprevir Approved Merck n/a daclatasvir + asunaprevir + beclabuvir Phase III Bristol-Myers Squibb *generic available What are they? Multi-class combination drugs are a combination of drugs formulated into a single pill or package of pills. For instance, the drug Harvoni combines two drugs, ledipasvir and sofosbuvir. Ledipasvir is an NS5A inhibitor and is only sold as part of Harvoni; sofosbuvir may be prescribed separately under the brand name of Sovaldi. Pegylated Interferon Alfa Brand Name Generic Name Status Pharmaceutical Company Pegasys peginterferon alfa-2a Approved Genentech What are they? Interferon is a protein made by the immune system, named because it interferes with viral reproduction. In addition, interferon signals the immune system to recognize and respond to microorganisms, including viral and bacterial infections. Infected cells release inter- feron to trigger the immune response. There are three types of interferon: alfa, beta and gamma. Interferon alfa is used to treat viral hepatitis and some types of cancer. Nucleoside Analogs Brand Name Generic Name Status Pharmaceutical Company Copegus, Moderiba and Ribasphere ribavirin Approved Genentech, AbbVie and Kadmon What are they? Although it is not effective against hepatitis C when used alone, ribavirin plays an important role in HCV combination treatment. Scientists have not determined exactly how it works. However, it is clear that combining ribavirin with some of the HCV direct-acting antivirals and/or pegylated interferon boosts cure rates and reduces the risk of relapse. hepmag.com Nucleotide NS5B Polymerase Inhibitors Brand Name Generic Name Status Pharmaceutical Company Sovaldi sofosbuvir Approved Gilead Sciences What are they? These drugs block the NS5B protein, which plays a role in the replication of HCV and is involved in creating copies of the viral RNA genome. Sovaldi is used to treat HCV genotypes 1, 2, 3 and 4 and is part of a once-a-day combination pill with the NS5A inhibitor ledipasvir. Sovaldi may also be combined with other drugs, such as Daklinza, Olysio, or ribavirin, depending on various factors. NS5A Inhibitors Brand Name Generic Name Status Pharmaceutical Company Daklinza daclatasvir Approved Bristol-Myers Squibb What are they? NS5A is an HCV protein, a part of the HCV replication complex (replicase), with multiple functions in the virus’s life cycle. Daklinza is used in combination with Sovaldi as a component of interferon- and ribavirin-free regimens. Last Revised: March 2019 hepmag.com