IDStewardship

Sofosbuvir/ velpatasvir/ voxilaprevir

Here is a helpful tip for these new hepatitis C virus drugs:

KEY POINTS

  • Sofosbuvir/ velpatasvir/ voxilaprevir (Vosevi, SOF/VEL/VOX) is the combination of three direct-acting antivirals that work against hepatitis C virus (HCV)
      • Sofosbuvir is a NS5B-inhibitor. It inhibits HCV  NS5B RNA-dependent RNA polymerase, which is an enzyme needed for viral replication.
      • Velpatasvir is an NS5A-inhibitor. It inhibits HCV replication by blocking NS5A protein.
      • Voxilaprevir is a NS3/4A protease inhibitor. It interferes with proteolytic cleavage of HCV.
  • FDA-approved in July 2017 for:
    • Re-treatment of patients with chronic HCV infection in adults due to genotype 1 through 6 previously treated with an NS5A-containing regimen
    • Patients with genotype 1a or 3 previously treated with a sofosbuvir-containing regimen without an NS5A-inhibitor
  • Single tablet taken once daily
    • Sofosbuvir 400 mg + velpatasvir 100 mg + voxilaprevir 100 mg
  • Duration and regimen selection for HCV treatment will typically include: genotype (and resistance), cirrhosis status, and treatment history
    • Common treatment duration is 12 weeks
    • Patients should receive proper screening prior to initiating therapy
  • Common side effects to beware include: diarrhea, fatigue, headache, and nausea
  • FDA Boxed Warning: beware hepatitis B virus reactivition in patients undergoing HCV therapy with direct-acting antivirals
  • Beware drug-drug interactions
    • P-gp inducers, CYP-2B6 inducers, CYP-2C8  inducers and CYP-3A4 inducers may reduce sofosbuvir/ velpatasvir/ voxilaprevir concentrations
      • Contraindicated with rifampin use
  • Beware serious bradycardia if administered with amiodarone
  • While a cost is not available as of yet, it can be expected that this drug will be very expensive

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