Published on HCV Guidance (https://www.hcvguidelines.org)

Sofosbuvir-Based and Elbasvir/Grazoprevir Treatment Failures

Recommended and alternative regimens listed by evidence level and alphabetically for: Sofosbuvir-Based Treatment Failures, With or Without Compensated Cirrhosis^a
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg)^b	12 weeks	I, A
ALTERNATIVE	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg) except for NS3/4 protease inhibitor inclusive combination DAA regimen failures^c Not recommended for genotype 3 infection with sofosbuvir/NS5A inhibitor experience.	16 weeks	I, A
^a For decompensated cirrhosis, please refer to the appropriate section. ^b Genotype 3: Add weight-based ribavirin if cirrhosis is present and there are no contraindications. ^c This regimen is not recommended for patients with prior exposure to an NS5A inhibitor plus NS3/4 PI regimens (e.g., elbasvir/grazoprevir).

Last update:

October 24, 2022

Glecaprevir/Pibrentasvir Treatment Failures

Recommended regimens listed by evidence level and alphabetically for: Glecaprevir/Pibrentasvir Treatment Failures (All Genotypes), With or Without Compensated Cirrhosis^a
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg) plus daily sofosbuvir (400 mg) and weight-based ribavirin	16 weeks	IIa, B
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg)	12 weeks	IIa, B

For patients with compensated cirrhosis, addition of weight-based ribavirin is recommended.	12 weeks	IIa, C
^a For decompensated cirrhosis, please refer to the appropriate section.

Last update:

October 24, 2022

Multiple DAA Treatment Failures (All Genotypes), Including Sofosbuvir/Velpatasvir/Voxilaprevir or Sofosbuvir Plus Glecaprevir/Pibrentasvir

Recommended regimens listed by evidence level and alphabetically for: Sofosbuvir/Velpatasvir/Voxilaprevir Treatment Failures, With or Without Compensated Cirrhosis^a
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg) plus daily sofosbuvir (400 mg) and weight-based ribavirin	16 weeks^b	IIa, B
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg) plus weight-based ribavirin	24 weeks	IIa, B
^a For decompensated cirrhosis, please refer to the appropriate section. ^b Extension of treatment to 24 weeks should be considered in extremely difficult cases (e.g., genotype 3 with cirrhosis) or failure following sofosbuvir plus glecaprevir/pibrentasvir.

Last update:

October 24, 2022