Hepatitis C treatment with Maviret – brief advice for Prescribers
Maviret is a new medication for the treatment of hepatitis C. It is a combination of two anti-viral medications Glecaprevir and Pibrentasvir, and is active against the 6 major strains (genotypes) of the virus. Cure rate is expected to be >95% It can be prescribed by any GP, Specialist or Nurse Practitioner It does not require a special authority or any special paperwork
Pre-treatment work-up: Bloods o HCV antibody; HCV RNA or HCV antigen, LFTs, AST, CBC , Hep B, HIV if has risk factors o AST - this is used to calculate APRI score (AST to Platelet Ratio) to assess fibrosis. The AST may not be included in the standard LFT panel, so it may need to be specifically requested Liver staging - FIBROSIS assessment is mandatory BEFORE treatment is started (this can be done using APRI score or by requesting a Fibroscan)
APRI score calculator https://www.hepatitisc.uw.edu/page/clinical-calculators/apri (Upper limit of the reference range is 40, enter 40 in the middle field of the calculator) APRI score <1.0: the chance of having liver cirrhosis is very low and no further tests, including Fibroscan, are needed prior to commencing treatment APRI score >1.0: patient may have liver cirrhosis and they should have a Fibroscan to further assess their liver prior to treatment Fibroscan (Use bpac eReferral for Fibroscan ) o Assesses liver scarring/fibrosis If the Fibroscan result is <12.5 kPa - patient can be treated in community. Once cured no follow up needed If the Fibroscan result is >12.5 kPa - patient will be treated in secondary care. (Patients will be monitored with carcinoma ultrasound surveillance after hepatitis C cure) Or you can refer directly for a Fibroscan without APRI score, especially for patients with challenging veins and all blood taken except AST
Maviret interactions: Maviret interacts with a small number of medications (including some statins and oral contraceptive pills). Check for interactions on www.hep-druginteractions.org There is no interaction with cannabis, methadone or buprenorphine (suboxone) Maviret is not recommended for use in liver failure (Child-Pugh B or C cirrhosis) Pharmacy: Not all pharmacies are able to dispense this medication. Go to https://maviret.co.nz/ to find a pharmacy that is able to dispense Maviret Maviret may not be held in stock, the pharmacy will call the patient back when it is ready for pick up (usually within a few days). There is no cost to patients. Treatment: Dose is 3 tablets, taken altogether once a day, with food, for 8, 12 or 16 weeks Duration depends on treatment experience, genotype and cirrhosis For all treatment naïve, non-cirrhotic patients treatment is only 8 weeks (if not treatment naïve – discuss with specialist) No “on treatment” blood test monitoring is required
Hepatitis C Treatment with Maviret – brief advice for prescribers (V0.1)
Author: Dr Alex Lampen-Smith, NZHF Clinical Director Localised by: Midland region hepatitis C team 02/20
12 weeks after treatment is finished recall for a HCV RNA blood test and LFT to check your patient has been cured and liver function is ok Cure does not give immunity; encourage harm reduction strategies for those at risk of re-infection.
For further information: View the “chronic hepatitis C pathway” in HealthPathways Contact Midland region hepatitis C nurse, Nancy Carey on mobile 021 549 658 for clinical support See the Medsafe Datasheet Liaise with your nearest Gastroenterology or Infectious Diseases specialists Visit www.maviret.co.nz For further background reading about hepatitis C see the recently updated BPAC hepatitis C guidelines For Midland region hep C support eg queries and bookings phone 0800-195-115 If you require prescribing support phone 0800-900-030 (AbbVie Care GP helpline)
NS5A inhibitors include Ledipasvir (part of Harvoni) and Daclatasvir (not funded in New Zealand but patients may have accessed it via the FixHepC website).
Hepatitis C Treatment with Maviret – brief advice for prescribers (V0.1)
Author: Dr Alex Lampen-Smith, NZHF Clinical Director Localised by: Midland region hepatitis C team 02/20