종류
- Glecaprevir / Pibrentasvir (GLE/PIB)
- Sofosbuvir / Velpatasvir (SOF/VEL)
- Sofosbuvir / Velpatasvir / Voxilaprevir (SOF/VEL/VOX)
Glecaprevir / Pibrentasvir (GLE/PIB)
- HCV 1~6형에 8주 요법 가능: 8주 요법으로 SVR 99~100%
- 이전 치료력이 있는 3형은 16주 요법: Genotype 3 의 경우 이전 치료력이 있는 환자에서 16주로 연장 치료 시 SVR ↑(91% -→ 95%)
- LC 환자는 12주 요법: LC 가 동반된 경우 12주 요법으로 SVR 99~100%
- CKD 환자에서도 사용 가능
Sofosbuvir / Velpatasvir (SOF/VEL)
- HCV 1~6형에 12주 요법 (LC 환자도 12주): 12주 사용시 HCV genotype 1~6 모두 SVR 95% 이상
Sofosbuvir / Velpatasvir / Voxilaprevir (SOF/VEL/VOX)
- 초치료로는 사용하지 않는다.-(SOF/VEL 12주 요법 vs. SOF/VEL/VOX 8주 요법 : SVR 98% vs, SVR 95%)
- 이전 DAA 치료 실패 환자에서 선택할 수 있는 가장 좋은 치료 옵션!
Pangenotypic regimens vs. Genotype-specific regimens
IFN-free, ribavirin-free combination treatment regimens: treatment-naïve patients and treatment-experienced patients without cirrhosis or with compensated (Child-Pugh A) cirrhosis
Genotype | Pangenotypic regimens | Genotype-specific regimens |
SOF/VEL | GLE/PIB | SOF/VEL/VOX | SOF/LDV | GZR/EBR | OBV/PTV/r +DSV |
Genotype 1a | Yes | Yes | No | Yesa | Yesb | No |
Genotype 1b | Yes | Yes | No | Yes | Yes | Yes |
Genotype 2 | Yes | Yes | No | No | No | No |
Genotype 3 | Yesc | Yes | Yesd | No | No | No |
Genotype 4 | Yes | Yes | No | Yesa | Yese | No |
Genotype 5 | Yes | Yes | No | Yesa | No | No |
Genotype 6 | Yes | Yes | No | Yesa | No | No |
treatment-naïve patients: patients who have never been treated for their HCV infection
treatment-experienced patients: patients who were previously treated with pegylated IFN-a and ribavirin; pegylated IFN-a, ribavirin and sofosbuvir; or sofosbuvir and ribavirin),
DSV, dasabuvir; EBR, elbasvir; GLE, glecaprevir; GZR, grazoprevir; IFN, interferon; LDV, ledipasvir; OBV, ombitasvir; PIB, pibrentasvir; PTV, paritaprevir; r, ritonavir; SOF, sofosbuvir; VEL, velpatasvir; VOX: voxilaprevir
Pan-genotypic DAA regimens
Genotype | GLE/PIB | | SOF/VEL | | SOF/VEL/VOX | |
TN | TE | TN | TE | TN | TE |
1, 2, 4, 5, 6 | Chronic hepatitis C | 8wk | 8wk | 12wk | 12wk | | |
Compensated cirrhosis | 12wk | 12wk | 12wk | 12wk | | |
3 | Chonic hepatitis C | 8wk | 16wk | 12wk | 12wk (+R) | | |
Compensated cirrhosis | 12wk | 16wk | 12wk (+R) | 12wk+R | | 12wk |
- 일반적인 초치료: SOF/VEL 12주 우선 시도
- 이전 DAA 치료에 효과가 없었던 경우: SOF/VEL/VOX 투여
참고자료
- 대한간학회. 만성B형간염 진료 가이드라인. 2017
- European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol 2018;69(2):461–511.
- AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis 2018;67(10):1477
- Baumert TF, Berg T, Lim JK, Nelson DR. Status of Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection and Remaining Challenges. Gastroenterology 2019;156(2):431–45.