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 |
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING 
|
| Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)a | 12 weeks | I, B |
| Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) | 12 weeks | I, B |
| Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) | 12 weeks | I, B |
| a Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information. | ||
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
|
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING
|
| Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) | 12 weeks | I, B |
| Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)a | 12 weeks | I, C |
| Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) | 12 weeks | I, A |
| a Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information. | ||
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 |
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING
|
| Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/ ribavirin starting at 600 mg and increased as toleratedb | 12 to 24 weeksc | I, B |
| 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 | 12 to 24 weeksc | I, B |
|
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. |
||
Recommended regimen for:DAA-Experienced Patients With Genotype 1-6 Infection in the Allograft, With or Without Compensated Cirrhosisa |
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING
|
| Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg)b | 12 weeks | I, C |
|
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. |
||
Table. DAA Interactions With Calcineurin Inhibitors
Cyclosporine (CSA) |
Tacrolimus (TAC) |
|
|---|---|---|
| Sofosbuvir (SOF) | 4.5-fold ↑ in SOF AUC, but GS-331007 metabolite unchanged; no a priori dose adjustment | No interaction observed; no a priori dose adjustment |
| Ledipasvir | No data; no a priori dose adjustment | No data; no a priori dose adjustment |
| Elbasvir / grazoprevir (EBR/GZR) | 15-fold ↑ in GZR AUC and 2-fold ↑ in EBR AUC; combination is not recommended | 43% ↑ in TAC; no a priori dose adjustment |
| Velpatasvir | No interaction observed; no a priori dose adjustment | No data; no a priori dose adjustment |
| Glecaprevir / pibrentasvir (GLE/PIB) | 5-fold ↑ in GLE AUC with higher doses (400 mg) of CSA; not recommended in patients requiring stable CSA doses >100 mg/day | 1.45-fold ↑ in TAC AUC; no a priori dose adjustment; monitor TAC levels and titrate TAC dose as needed |
| Sofosbuvir / velpatasvir / voxilaprevir (SOF/VEL/VOX) | 9.4-fold ↑ in VOX AUC; combination is not recommended | No data; no a priori dose adjustment |
| AUC=area under the curve | ||
