IDStewardship

Elbasvir/ grazoprevir

[Elbasvir/grazoprevir photo]

KEY POINTS

  • Elbasvir/ grazoprevir (Zepatier) is a combination pill used to treat hepatitis C virus (HCV) infection
    • Elbasvir is an NS5A inhibitor, it blocks HCV NS5A which interferes with viral replication and virion assembly
    • Grazoprevir is an NS3/4A inhibitor, which blocks HCV NS3/A4 and interferes with proteolytic cleavage of HCV-encoded polyprotein essential for viral replication
  • Refer to HCV treatment guidelines for treatment duration and when it is indicated
    • FDA-approved for treatment of HCV genotpype 1 or 4 in adults
    • Has activity against HCV genotype 3
    • May be used with other medications (e.g., ribavirin or sofosbuvir) when treating certain HCV genotypes
    • Resistance testing for genotype 1a patients may be done to identify the presence of NS5A resistance-associated polymorphisms
  • Duration and regimen consideration typically include: genotype (and resistance), cirrhosis status, and treatment history
    • 12 weeks is a common treatment duration
    • Patients should receive proper screening prior to initiating therapy
  • Common dose is one tablet (elbasvir 50mg + grazoprevir 100mg) once daily
    • Patients should be advised not to miss doses to increase chances of treatment success
  • Beware drug-drug interactions
  • Beware liver enzyme elevations, fatigue, headache and nausea (amongst other possible adverse effects)
    • Generally well tolerated
  • Only available brand-name in the United States and is extremely expensive, meaning a treatment course without insurance can be many tens of thousands of dollars

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