E-HEP

Product Description

Sofosbuvir, sold under the brand name  among others, is a medication used for the treatment of hepatitis C.^[1] It is only recommended with some combination of ribavirin, peginterferon-alfa, simeprevir, ledipasvir, daclatasvir, or velpatasvir.^[3][4] Cure rates are 30 to 97% depending on the type of hepatitis C virus involved.^[5] Safety during pregnancy is unclear; while, some of the medications used in combination may result in harm to the baby.^[5] It is taken by mouth.^[1]

Common side effects include feeling tired, headache, nausea, and trouble sleeping.^[1] Side effects are generally more common in interferon-containing regimens.^[6]:7 Sofosbuvir may reactivate hepatitis B in those who have been previously infected.^[7] In combination with ledipasvir, daclatasvir or simeprevir it is not recommended with amiodarone due to the risk of an abnormally slow heartbeat.^[6] Sofosbuvir is in the nucleotide analog family of medication and works by blocking the hepatitis C NS5B protein.^[8]

Sofosbuvir was discovered in 2007 and approved for medical use in the United States in 2013.^[3][9] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.^[10] As of 2016 a 12-week course of treatment costs about $84,000 in the United States, $53,000 in the United Kingdom, $45,000 in Canada, and $483 in India.^[11] Over 60,000 people were treated with sofosbuvir in its first 30 weeks being sold in the United States.^[12]

Medical uses

Initial HCV treatment

In 2016, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America jointly published a recommendation for the management of hepatitis C. In this recommendation, sofosbuvir used in combination with other drugs is part of all first-line treatments for HCV genotypes 1, 2, 3, 4, 5, and 6, and is also part of some second-line treatments.^[13] Sofosbuvir in combination with velpatasvir is recommended for all genetypes with a cure rate greater than 90%, and close to 100% in most cases. The duration of treatment is typically 12 weeks.^[13][14]

Sofosbuvir is also used with other medications and longer treatment durations, depending on specific circumstances, genotype and cost-effectivenessbased perspective. For example, for the treatment of genotypes 1, 4, 5, and 6 hepatitis C infections, sofosbuvir can be used in combination with the viral NS5A inhibitor ledipasvir. In genotype 2 and 3 HCV infections, sofosbuvir can be used in combination with daclatasvir. For the treatment of cases with cirrhosis or liver transplant patients, weight-based ribavirin is sometimes added. Peginterferon with or without sofosbuvir is no longer recommended in an initial HCV treatment.^[13]

Compared to previous treatments, sofosbuvir-based regimens provide a higher cure rate, fewer side effects, and a two- to four-fold reduced duration of therapy.^[15][16][17] Sofosbuvir allows most people to be treated successfully without the use of peginterferon, an injectable drug with severe side effects that is a key component of older drug combinations for the treatment of hepatitis C virus.