From Interferon to Vosevi: 8 Hepatitis C Medications to Know About
Key takeaways:
Hepatitis C is a common liver infection with several different treatment options. Treatment is usually guided by your age, type of hepatitis C virus (genotype), and liver function.
Interferons and ribavirin are older hepatitis C medications that are rarely used today due to a low cure rate and a high risk of side effects.
Direct-acting antivirals (DAAs) are now the standard of care for treating hepatitis C, with a cure rate that exceeds 90%. Common examples include Epclusa (sofosbuvir / velpatasvir) and Mavyret (glecaprevir / pibrentasvir). DAAs can be expensive, but there are ways to save on the cost through copay cards and patient assistance programs.
Table of contents
Hepatitis C is the most common type of hepatitis in the U.S., with at least 2 million people affected between 2013 and 2016. It’s a liver infection caused by the hepatitis C virus (HCV). And unlike other forms of hepatitis, it’s not likely to go away on its own. But hepatitis C is a very treatable disease — over 90% of people who receive treatment are cured. The problem is, about 40% of people with hepatitis C aren’t aware they have it. That’s why all adults should receive a hepatitis C test at least once in their lifetime.
Treatment for hepatitis C is generally guided by several factors including age, type of HCV (also known as the virus genotype), and severity of liver damage. Let’s take a closer look at eight common hepatitis C medications, from oldest to newest.
1. Interferons
Interferons were the first hepatitis C medications available. They work by helping your immune system fight off HCV. And they also help stop viruses — including HCV — from replicating and spreading throughout the body.
Save over 75% on Vascepa with GoodRx
Is your heart at risk? Help protect your heart with Vascepa.
Pegasys (peginterferon alfa-2a) is a common brand of pegylated interferon used for HCV. It helps treat chronic hepatitis C (CHC), also known as long-term hepatitis C, in people ages 5 years and older. It’s given as an injection under the skin (subcutaneously) once a week. And it’s meant to be combined with other antiviral medications. Treatment duration generally ranges from 24 to 48 weeks (about 6 to 11 months).
Unfortunately, interferons don’t work very well for HCV on their own, and the infection often returns after treatment. They also require treatment over a long period of time and cause frequent side effects. Serious side effects are also an issue, including mental health problems, autoimmune reactions, and infections. Due to these reasons, interferons are rarely used nowadays to treat hepatitis C.
2. Ribavirin
Due to the problems associated with interferon, ribavirin was FDA approved in 1998 as a new hepatitis C medication. It’s an antiviral that treats CHC in adults and children as young as 3 years old. Ribavirin stops the spread of HCV by preventing the virus from making copies of itself.
Ribavirin is currently available in oral tablets and capsules for hepatitis C. The dose is typically based on your body weight. Ribavirin must be taken along with pegylated interferon — it’s not effective on its own. And a course of treatment can range from 24 to 48 weeks.
The addition of ribavirin to interferon proved to be more effective than interferon alone, with a 40% to 50% cure rate. This combination was considered the standard of care for hepatitis C for over a decade.
But ribavirin has some risks and side effects that can be very concerning. It can cause your body to destroy red blood cells (hemolytic anemia), which can worsen heart disease. Ribavirin can also cause serious harm to an unborn baby. You shouldn’t take it if you or your partner are pregnant or plan to become pregnant.
How to save: Ribavirin is only available as a generic product. GoodRx can help you save over 60% off the cost with a free discount.
Direct-acting antivirals
In 2011, a drug class called direct-acting antivirals (DAAs) emerged as a new treatment option for hepatitis C. DAAs were a game changer, with a cure rate of over 90%. These hepatitis C medications prevent the spread of HCV by blocking certain enzymes (proteins) the virus needs in order to replicate and spread.
Not only are DAAs more effective than previous HCV treatments, they require a shorter treatment course. In most cases, you’ll take them for 8 to 12 weeks (2 to 3 months). DAAs are now considered the gold standard for hepatitis C treatment.
As mentioned, there are different types of the hepatitis C virus, known as genotypes 1 through 6. Each DAA treats a specific set of genotypes. So you’ll need a genotype test to help decide which treatment option is best for you.
It’s important to note that DAAs can worsen or reactivate a hepatitis B infection. So you’ll need a blood test for hepatitis B prior to starting a DAA.
Now, let’s dive into some common DAAs.
3. Sovaldi
Sovaldi (sofosbuvir) was one of the first available DAAs on the market. It’s approved for CHC genotypes 1 and 4 in adults, taken along with pegylated interferon and ribavirin. It’s also approved for genotypes 2 and 3 in adults and children ages 3 and older, taken along with ribavirin.
Sovaldi comes in tablets as well as oral pellets that are a helpful option for those who have trouble swallowing tablets. The adult dosage is 400 mg by mouth once daily with or without food. Dosing for children is based on body weight. The most common side effects are fatigue and headache.
Sovaldi can cause a dangerously low heart rate if it’s combined with amiodarone (Pacerone). So it’s best to avoid this combination. And be aware that the active ingredient in Sovaldi is also included in several other combination DAA medications.
How to save: Sovaldi is only available as a brand-name medication. If you have commercial insurance, a copay savings program from the manufacturer can help you save up to 25% off your cost.
4. Harvoni
Harvoni is a combination DAA medication that contains two ingredients: sofosbuvir and ledipasvir. It’s approved for CHC genotypes 1, 4, 5, and 6 in adults and children ages 3 and older. It can be taken alone, but it’s combined with ribavirin in some cases.
Like Sovaldi, Harvoni comes in tablets and oral pellets. The adult dosage is 400 mg sofosbuvir / 90 mg ledipasvir by mouth once daily with or without food. Dosing for children is based on body weight. Common side effects include fatigue, headache, and weakness.
Harvoni is ideal for adults living with kidney issues, as no dose adjustment is required. However, Harvoni does have several drug interactions to consider. So be sure to provide an updated medication list to your prescriber so they can review it for any possible issues.
How to save: Harvoni is available as both a brand-name and generic medication. GoodRx can help you save over 70% off the cost of the generic version. And a savings program is available for brand-name Harvoni that provides savings for both commercially insured and uninsured or underinsured people.
5. Epclusa
Epclusa is a combination DAA medication that contains two ingredients: sofosbuvir and velpatasvir. It’s approved for all CHC genotypes (1 through 6) in adults and children ages 3 and older. It can be taken on its own, but ribavirin may be added if you have more advanced liver damage. Epclusa is a first-choice option for treating HCV if you haven’t tried any other treatment options.
Epclusa comes in oral tablets and pellets. The adult dosage is 400 mg sofosbuvir / 100 mg velpatasvir by mouth once daily with or without food. Dosing for children is based on body weight. Common Epclusa side effects include headache and fatigue.
Similar to Harvoni, Epclusa is safe for people with kidney problems without a dose adjustment.
How to save: Epclusa is available as both a brand-name and generic medication. GoodRx can help you save over 60% off the cost of the generic version. If you have commercial insurance, a copay savings program is available for brand-name Epclusa. A patient assistance program is also available.
6. Mavyret
Mavyret is a combination DAA medication that contains two medications: glecaprevir and pibrentasvir. Like Epclusa, it’s FDA approved for all CHC genotypes in adults and children ages 3 and older. It’s another first-choice treatment option for HCV if no other treatments have been tried.
Mavyret comes in oral tablets and pellets. The adult dosage is 3 tablets once daily with food. Each tablet contains 100 mg glecaprevir / 40 mg pibrentasvir. Dosing for children is based on body weight. The most common Mavyret side effects are headache and fatigue.
Mavyret isn’t recommended for people living with more advanced liver disease. It’s also not recommended if you’re currently taking rifampin or atazanavir (Reyataz). Each of these medications can change the levels of Mavyret in the body if they’re combined.
How to save: Mavyret is only available as a brand-name medication. If you have commercial insurance, your monthly copay could be as low as $5 with a savings card from the manufacturer. A patient assistance program is also available.
7. Zepatier
Zepatier is a combination DAA that contains two medications: elbasvir and grazoprevir. It’s only approved for CHC genotypes 1 and 4 in adults and children ages 12 or older (or who weigh at least 30 kg). Zepatier can be used on its own but is combined with ribavirin in certain cases.
Zepatier only comes in oral tablets. The recommended dosage for both adults and children is 50 mg elbasvir / 100 mg grazoprevir by mouth once daily with or without food. Like other DAAs, the most common side effects are fatigue, headache, and nausea.
Zepatier is not recommended for people who have more advanced liver disease.
How to save: Zepatier is only available as a brand-name medication. But a patient assistance program is available to help you save on the cost.
8. Vosevi
Vosevi is a combination DAA that contains three medications: sofosbuvir, velpatasvir, and voxilaprevir. It’s approved for all CHC genotypes, but only in adults. Vosevi isn’t typically a first-choice treatment for HCV. It’s generally only prescribed after other hepatitis C medications haven’t worked.
Vosevi is only available in oral tablets. The recommended dosage is one tablet daily with food, containing 400 mg sofosbuvir / 100 mg velpatasvir / 100 mg voxilaprevir. Headache, fatigue, and diarrhea are common side effects.
Vosevi isn’t recommended if you have moderate-to-severe liver problems.
How to save: Vosevi is only available as a brand-name medication. Copay savings as well as a patient assistance program are available from the manufacturer.
Which hepatitis C treatment is right for you?
There are several factors to consider when choosing a hepatitis C treatment. Your age, virus genotype, and liver function are just a few things that can help determine which hepatitis C medication is right for you. It also makes a difference if previous treatments have been unsuccessful.
Additionally, you may want to consider drug interactions, side effects, and cost when choosing a hepatitis C medication. While DAAs are the most effective treatment options, their cost can be a burden for some people. Your healthcare team can help choose an appropriate and affordable treatment option.
The bottom line
Currently, direct-acting antivirals (DAAs) are the most effective hepatitis C medications available. Epclusa (sofosbuvir / velpatasvir) and Mavyret (glecaprevir / pibrentasvir) are two common options. DAAs also have a shorter treatment duration and less side effects than interferons and ribavirin. That being said, DAAs can be expensive and may not be ideal if you have a history of hepatitis B infection.
Your healthcare team can help you understand the risks, benefits, and treatment cost to decide on a treatment option. They can also help you find assistance programs to help cover the medication cost, if needed.
Why trust our experts?
References
AbbVie Inc. (2023). Mavyret [package insert].
American Association for the Study of Liver Diseases, et al. (2021). Initial treatment of adults with HCV infection.
Aurobindo Pharma USA, Inc. (2023). Ribavirin [package insert].
Baldwin, C., et al. (2023). Hemolytic anemia. StatPearls.
Centers for Disease Control and Prevention. (2022). Hepatitis awareness month.
Centers for Disease Control and Prevention. (2023). Testing recommendations for hepatitis C infection.
Falade-Nwulia, O., et al. (2017). Oral direct-acting agent therapy for hepatitis C virus infection. Annals of Internal Medicine.
Friedman, R. M., et al. (2010). Treatment of hepatitis C infections with interferon: A historical perspective. Hepatitis Research and Treatment.
Geddawy, A., et al. (2017). Direct acting anti-hepatitis C virus drugs: Clinical pharmacology and future direction. Journal of Translational Internal Medicine.
Gilead Sciences, Inc. (2019). Vosevi [package insert].
Gilead Sciences, Inc. (2020). Harvoni [package insert].
Gilead Sciences, Inc. (2020). Sovaldi [package insert].
Gilead Sciences, Inc. (2022). Epclusa [package insert].
Henry, B. (2018). Drug pricing & challenges to hepatitis C treatment access. Journal of Health and Biomedical Law.
Khanna, N. R., et al. (2023). Interferon. StatPearls.
Merck Sharp & Dohme Corp. (2021). Zepatier [package insert].
Oancea, C. N., et al. (2020). Global hepatitis C elimination: History, evolution, revolutionary changes and barriers to overcome. Romanian Journal of Morphology and Embryology.
Palumbo, E. (2011). Pegylated interferon and ribavirin treatment for hepatitis C virus infection. Therapeutic Advances in Chronic Disease.
Pisaturo, M., et al. (2019). Hepatitis B virus (HBV) reactivation following pharmacological eradication of hepatitis C virus (HCV). Viruses.
Treatment Action Group. (2017). HCV genotypes.
U.S. Department of Health and Human Services. (2022). Hepatitis C basic information.
Zr Pharma& GmbH. (2023). Pegasys [package insert].
