The European Association for the Study of the Liver (EASL) presented updated recommendations for the treatment of hepatitis C, adopted at a special meeting in Paris. Last year, the recommendations were traditionally presented at the annual Congress. Hepatitis C treatment regimens in 2021
The updated guidelines no longer provide for the treatment of viral hepatitis C (HCV) with pegylated interferon-based regimens, thus ending the era of interferon therapy for hepatitis C in the EU countries.
Also, regimens based on one direct-acting drug are excluded from the manual. In the updated guidelines, for individual conditions, indications appeared that it is possible to correct some regimens for duration or for enhancement with ribavirin, provided that tests for detecting drug resistance mutations are performed.
The pangenotypic combination Sofosbuvir + Velpatasvir is recommended for the treatment of all genotypes, however, European experts have added Ribavirin to the therapy regimens for patients who have previously received peginterferon-based therapy, which differs from the American AASLD recommendations, where Ribavirin for this combination is provided only in patients who have failed for therapy with Telaprevir, Boceprevir or Simeprevir, as well as in patients with liver cirrhosis.
Table 1
EASL recommendations for the treatment of HCV monoinfection or HIV / HCV coinfection in patients without cirrhosis , including F0-F3 * fibrosis, who have not previously received therapy.
| Patient group | Ledipasvir + Sofosbuvir | Sofosbuvir + Daclatasvir | Velpatasvir + Sofosbuvir |
| Genotype 1a Genotype 1b | 12 weeks without ribavirin | 12 weeks without ribavirin | 12 weeks without ribavirin |
| Genotype 2 | No | 12 weeks without ribavirin | 12 weeks without ribavirin |
| Genotype 3 | No | 12 weeks without ribavirin | 12 weeks without ribavirin |
| Genotype 4 | 12 weeks without ribavirin | 12 weeks without ribavirin | 12 weeks without ribavirin |
* - with F3 fibrosis, in some cases, it is recommended to correct treatment regimens in terms of duration or enhancement with ribavirin.
table 2
EASL recommendations for the treatment of HCV monoinfection or HIV / HCV coinfection in patients with compensated cirrhosis (Child-Pugh class A), including F4 fibrosis , who have not previously received therapy.
| Patient group | Ledipasvir + Sofosbuvir | Sofosbuvir + Daclatasvir | Velpatasvir + Sofosbuvir |
| Genotype 1a Genotype 1b |
12 weeks with ribavirin or 24 weeks without ribavirin or 24 weeks with ribavirin if poor predictors of response |
12 weeks with ribavirin or 24 weeks without ribavirin |
12 weeks without ribavirin |
| Genotype 2 | No | 12 weeks without ribavirin or 24 weeks with ribavirin if poor predictors of response |
12 weeks without ribavirin |
| Genotype 3 | No | 24 weeks with ribavirin | 12 weeks with ribavirin or 24 weeks without ribavirin |
| Genotype 4 | 12 weeks with ribavirin or 24 weeks without ribavirin or 24 weeks with ribavirin if poor predictors of response |
12 weeks with ribavirin or 24 weeks without ribavirin |
12 weeks without ribavirin |
note
This information is for informational purposes only and is not a direct guide to treatment, and also does not exclude observation by a doctor! Hepatitis C treatment regimens in 2021