Summary of Recommendations for Patients with Decompensated Cirrhosis

Summary of Recommendations for Patients with Decompensated Cirrhosis

 

Recommended for All Patients with HCV Infection Who Have Decompensated Cirrhosis

Recommended Regimens for Patients with HCV Genotype 1, 4, 5, or 6 Infection Who HaveDecompensated Cirrhosis (Moderate or Severe Hepatic Impairment; CTP Class B or C) Who May or May Not Be Candidates for Liver Transplantation, Including Those with Hepatocellular Carcinoma
Recommended regimens are listed in groups by level of evidence, then alphabetically.

  • Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increased as tolerated) for 12 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who have decompensated cirrhosis.
    Rating: Class I, Level A
  • Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirin|| for 12 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who have decompensated cirrhosis.
    Rating: Class I, Level A
  • Daily daclatasvir (60 mg*) plus sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increased as tolerated) for 12 weeks is a Recommended regimen for patients with HCV genotype 1 or 4 infection who have decompensated cirrhosis.
    Rating: Class I, Level B

 

|| Low initial dose of ribavirin (600 mg) is recommended for patients with CTP class C.

*The dose of daclatasvir may need to increase or decrease when used concomitantly with cytochrome P450 3A/4 inducers and inhibitors, respectively. Please refer to the prescribing information for daclatasvir.

Only available data for genotype 6 are in patients with compensated cirrhosis.

Only available data for genotype 5 and 6 are in small number of patients with compensated cirrhosis.

 

Recommended Regimens for Patients with HCV Genotype 1, 4, 5, or 6 Infection Who HaveDecompensated Cirrhosis and Are Ribavirin Ineligible
Recommended regimens are listed in groups by level of evidence, then alphabetically.

  • Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) for 24 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who havedecompensated cirrhosis and are ribavirin ineligible.
    Rating: Class I, Level A
  • Daily daclatasvir (60 mg*) plus sofosbuvir (400 mg) for 24 weeks is a Recommended regimen for patients with HCV genotype 1 or 4  infection who have decompensated cirrhosis and are ribavirin ineligible.
    Rating: Class II, Level C
  • Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for 24 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who havedecompensated cirrhosis and are ribavirin ineligible.
    Rating: Class II, Level C

 

*The dose of daclatasvir may need to increase or decrease when used concomitantly with cytochrome P450 3A/4 inducers and inhibitors, respectively. Please refer to the prescribing information for daclatasvir.

Only available data for genotype 6 are in patients with compensated cirrhosis.

Only available data for genotype 5 and 6 are in small number of patients with compensated cirrhosis.

 

Recommended Regimens for Patients with HCV Genotype 1, 4, 5, or 6 Infection Who HaveDecompensated Cirrhosis and in Whom Prior Sofosbuvir-based or NS5A-based Treatment Has Failed

Recommended regimens are listed in groups by level of evidence, then alphabetically.

  • Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increased as tolerated) for 24 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who have decompensated cirrhosis and in whom prior sofosbuvir-based treatment has failed.
    Rating: Class II, Level C
  • Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirin|| for 24 weeks is a Recommended regimen for patients with HCV genotype 1, 4, 5, or 6 infection who have decompensated cirrhosis and in whom prior sofosbuvir-based or NS5A-based treatment has failed.
    Rating: Class II, Level C

|| Low initial dose of ribavirin (600 mg) is recommended for patients with CTP class C.

Only available data for genotype 6 are in patients with compensated cirrhosis.

Only available data for genotype 5 and 6 are in small number of patients with compensated cirrhosis.

 

Recommended Regimens for Patients with HCV Genotype 2 or 3 Infection Who HaveDecompensated Cirrhosis (Moderate or Severe Hepatic Impairment; CTP Class B or C) and Who May or May Not Be Candidates for Liver Transplantation, Including Those with Hepatocellular Carcinoma

  • Daily fixed-dose combination sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirin for 12 weeks is a Recommended regimen for patients with HCV genotype 2 or 3 infection who have decompensated cirrhosis and who may or may not be candidates for liver transplantation including those with hepatocellular carcinoma.
    Rating: Class I, Level A
  • Daily daclatasvir (60 mg*) plus sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increased as tolerated) for 12 weeks is a Recommended regimen for patients with HCV genotype 2 or 3 infection who have decompensated cirrhosis and who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma.
    Rating: Class II, Level B

 

*The dose of daclatasvir may need to increase or decrease when used concomitantly with cytochrome P450 3A/4 inducers and inhibitors, respectively. Please refer to the prescribing information for daclatasvir.

Changes made April 12, 2017.

You are using an outdated browser, please upgrade your browser or download Firefox or Chrome.