Newly Updated EASL 2015 HCV Guidelines
Posted on May 5, 2015
EASL 2015 HCV Guideline Recommendations: Summary Document and Full Report are Now Available for Download in Our American Journal of Medicine Hepatitis C Resource Center
The European Association for the Study of the Liver (EASL) released its latest hepatitis C treatment guidelines at the 50th International Liver Congress, which took place last month in Vienna, Austria. Liz Highleyman, in collaboration with hivandhepatitis.com, has written an excellent commentary about how these newly updated guidelines are expected to change the approach of clinicians to treating this chronic infection (www.aidsmap.com/page/2965042/). The 2015 guidelines recommend a variety of interferon-free direct-acting antiviral (DAA) regimens approved in the European Union for people with hepatitis C virus genotypes 1-6, and recommendations are also made for patient groups that remain difficult to treat, such as those with decompensated cirrhosis.
The EASL 2015 guideline recommendations on treatment of hepatitis C 2015 are now available for download in our American Journal of Medicine Hepatitis C Resource Center (hepcresource.amjmed.com). These guidelines are also published in the April online edition of the Journal of Hepatology and available on the EASL website.
While the guidelines state that “All treatment-naive and treatment-experienced patients with compensated or decompensated chronic liver disease related to HCV, who are willing to be treated and who have no contraindications to treatment, should be considered for therapy,” they acknowledge that “because not every HCV-infected patient can be treated within the next year or so, prioritization is necessary.” Treatment priority is assigned based on liver fibrosis stage, risk of progression, extra-hepatic manifestations and likelihood of HCV transmission.
Liz Highleyman noted that the following HCV treatment regimens are included in the new guidelines:
- Sofosbuvir + ribavirin: genotypes 2 and 3
- Sofosbuvir/ledipasvir +/- ribavirin: genotypes 1, 4, 5, and 6
- Paritaprevir/ritonavir/ombitasvir + dasabuvir +/- ribavirin: genotype 1
- Sofosbuvir + simeprevir +/- ribavirin: genotypes 1 and 4
- Sofosbuvir + daclatasvir +/- ribavirin: all genotypes
- Paritaprevir/ritonavir/ombitasvir +/- ribavirin: genotype 4
- Pegylated interferon alfa-2a + ribavirin + sofosbuvir: all genotypes
- Pegylated interferon alfa-2a + ribavirin + simeprevir: genotypes 1 and 4
It was also noted that across genotypes, only a few regimens are recommended for people with decompensated cirrhosis: sofosbuvir plus ribavirin (genotype 2 and 3), and sofosbuvir with either ledipasvir (genotypes 1, 4, 5, and 6) or daclatasvir (all genotypes). In addition to specific antiviral regimens, the guidelines also include recommendations on monitoring during treatment, managing side-effects and drug-drug interactions, improving adherence and options for re-treatment of non-responders.