Direct Acting Antivirals (DAAs) Comparison

Since the time I graduated, there have been many new drugs for HCV treatment. Fortunately I can keep myself updated due to lots of prescriptions for Hep C treatment at my pharmacy. The important things to know about DAAs are the drug-drug interactions with other medications such as proton pump inhibitors (PPIs), H2 blockers, antacids, statins. For genotype 1, Zepatier is preferred because there are less interactions.

Here is a cheat sheet for me to remember:

	Harvoni (sofosbuvir + ledipasvir):  genotype 1, 4, 5, 6 Tx for 8 weeks	Epclusa (sofosbuvir + velpatasvir):  genotype 1, 2, 3, 4, 5, 6 Tx for 12 weeks	Mavyret (glecaprevir + pibrentasvir): genotype 1, 2, 3, 4, 5, 6 Tx for 8 weeks	Zepatier (grazoprevir + elbasvir): genotype 1, 4 Tx for 12 weeks
PPIs	Take with Harvoni after overnight fast on an empty stomach	4 hours separate from Epclusa	No interactions	No interactions
H2 Blockers	12  hours separate from Harvoni	12 hours separate from Epclusa	No interactions	No interactions
Antacids	At least 4 hours separate from Harvoni	At least 4 hours separate from Epclusa	No interactions	No interactions
Statins	– Avoid rosuvastatin – OK with atorvastatin 20 mg, simvastatin 20 mg	OK with rosuvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg	– Avoid simvastatin, atorvastatin – OK with rosuvastatin 10 mg	OK with rosuvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg
Do NOT take together	Strong CYP inducers (Oxcarbazepine, carbamazepine, phenytoin, phenobarbital), rifampin, amiodarone	Strong CYP inducers, rifampin, amiodarone	Strong CYP inducers, rifampin, dabigatran	Strong CYP inducers, rifampin

Naming convention:

-previr: NS3/4A protease inhibitor

-asvir: NS5A phosphoprotein inhibitor in Hepatitis C RNA replication

-buvir: NS5B RNA polymerase inhibitor

(Courtesy of intechopen.com – Hepatitis C life cycle and DAAs’ targets)