Elbasvir and grazoprevir for the treatment of hepatitis C

ABSTRACT

Introduction: Hepatitis C is one of the leading causes of chronic liver disease. The direct-acting-antivirals has revolutionized the chronic hepatitis C treatment. DAAs can achieve a sustained virological response rate >95% in different populations.

Area covered: This review summarizes the pharmacokinetics, pharmacodynamics, efficacy, and safety of Elbasvir/Grazoprevir (EBR/GZR).

Expert opinion: EBR/GZR is a combination of NS5A and NS3/4A inhibitors. The performance in the EBR/GZR combination’s safety and tolerability is appreciated in clinical treatment. EBR/GZR also has a higher barrier to resistance-associated substitutions. Based on clinical trials and real-world experience, elbasvir/grazoprevir is effective in the HCV GT1, 4 infections.

KEYWORDS:

• Direct-acting antivirals
• elbasvir
• grazoprevir
• hepatitis C virus
• genotype 1 or 4
• sustained viral response
• efficacy
• safety
• tolerability
• drug-drug interaction

Article highlights

1. EBR/GZR doesn’t need to adjust the dose in patients with any renal insufficiency. However, it contraindicates to patients with decompensated cirrhosis.

2. EBR/GZR has excellent SVR rate and tolerability in HCV GT1, 4-infected populations, even in challenging patients with CKD stage 4-5, HIV coinfection, compensated cirrhosis, treatment-experienced individuals, and special populations groups.

3. The GT1a-infected patients treated with EBR/GZR showed a lower sustained-viral-response rate. They had ≥1 baseline NS5A resistance-related-associated polymorphism. Checking NS5A RASs is necessary before the HCV GT1a treatment.

4. EBR and GZR are the substrates of CYP3A/P-glycoprotein. Drug-drug interactions are needed to consider.

Declaration of interest

M-L Yu received research grants from Abbvie, BMS, Gilead, Merck, and Roche; Consultancy and acted as a speaker for Abbvie, Ascletis, BMS, Gilead, Merck, Novartis, Pharmaessential, and Roche. C-F Huang has served as a speaker for AbbVie, Abbot, BMS, Gilead, and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was supported partly by grants from Kaohsiung Medical University Hospital (KMUH105-5R04, KMUH106-6R07) and Yuan’s General Hospital (YGH 18-007). The authors also thank the secretary help from Taiwan Liver Research Foundation (TLRF). The foundation did not influence the approval of the manuscript.