Summary: Patients Who Develop Recurrent HCV Infection Post Liver Transplantation
Post Liver Transplantation: Genotype 1-6
Recommended regimens listed by pangenotypic activity, evidence level and alphabetically for:
Treatment-Naive and -Experienced Patients With Genotype 1-6 Infection in the Allograft Without Cirrhosis
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RECOMMENDED
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DURATION
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RATING 
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Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)a
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12 weeks
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I, B
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
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12 weeks
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I, B
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Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg)
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12 weeks
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I, B
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a Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information.
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Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Treatment-Naive and -Experienced Patients With Genotype 1-6 Infection in the Allograft With Compensated Cirrhosis 
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RECOMMENDED
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DURATION
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RATING
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
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12 weeks
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I, B
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Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)a
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12 weeks
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I, C
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Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg)
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12 weeks
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I, A
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a Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information.
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Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Treatment-Naive and -Experienced Patients With Genotype 1-6 Infection in the Allograft and Decompensated Cirrhosisa
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RECOMMENDED
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DURATION
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RATING
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/ ribavirin starting at 600 mg and increased as toleratedb
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12 to 24 weeksc
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I, B
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Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increase as tolerated)b
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12 to 24 weeksc
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I, B
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a Includes CTP class B and class C patients.
b The starting dose of ribavirin should be 600 mg/d and increased or decreased as tolerated. If renal dysfunction is present, a lower starting dose is recommended. Maximum ribavirin dose is 1000 mg/d if <75 kg and 1200 mg/d if ≥75 kg body weight.
c 24-week treatment duration is recommended if treatment experienced.
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Recommended regimen for:
DAA-Experienced Patients With Genotype 1-6 Infection in the Allograft, With or Without Compensated Cirrhosisa
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RECOMMENDED
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DURATION
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RATING
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg)b
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12 weeks
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I, C
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a Excludes CTP class B and class C patients.
b For patients with cirrhosis plus multiple negative baseline characteristic, consideration should be given to adding ribavirin. The starting dose of ribavirin should be 600 mg/d and increased or decreased as tolerated. If renal dysfunction is present, a lower starting dose is recommended. Maximum ribavirin dose is 1000 mg/d if <75 kg and 1200 mg/d if ≥75 kg body weight.
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Table. DAA Interactions With Calcineurin Inhibitors
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Cyclosporine (CSA)
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Tacrolimus (TAC)
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Sofosbuvir (SOF)
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4.5-fold ↑ in SOF AUC, but GS-331007 metabolite unchanged; no a priori dose adjustment
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No interaction observed; no a priori dose adjustment
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Ledipasvir
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No data; no a priori dose adjustment
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No data; no a priori dose adjustment
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Elbasvir / grazoprevir (EBR/GZR)
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15-fold ↑ in GZR AUC and 2-fold ↑ in EBR AUC; combination is not recommended
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43% ↑ in TAC; no a priori dose adjustment
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Velpatasvir
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No interaction observed; no a priori dose adjustment
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No data; no a priori dose adjustment
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Glecaprevir / pibrentasvir (GLE/PIB)
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5-fold ↑ in GLE AUC with higher doses (400 mg) of CSA; not recommended in patients requiring stable CSA doses >100 mg/day
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1.45-fold ↑ in TAC AUC; no a priori dose adjustment; monitor TAC levels and titrate TAC dose as needed
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Sofosbuvir / velpatasvir / voxilaprevir (SOF/VEL/VOX)
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9.4-fold ↑ in VOX AUC; combination is not recommended
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No data; no a priori dose adjustment
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AUC=area under the curve
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