Mavyret
glecaprevir/pibrentasvir (GLE/PIB)
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Standard Dose
Three tablets once daily with food for adults and adolescents aged 12 years and up and weighing 99 pounds or more (≥45 kg). It is important to take all three tablets at the same time—do not separate throughout the day. Each tablet contains 100 mg of glecaprevir and 40 mg of pibrentasvir for a total daily dose of 300 mg/120 mg. Lower-dose pellets are available for pediatric patients aged 3 and up and weighing less than 99 pounds. Treatment is usually 8 weeks, but recommendations vary depending on genotype, treatment history, cirrhosis status, and presence of HIV coinfection. SEE treatment duration recommendations at hcvguidelines.org.Take missed dose as soon as possible unless it is less than 12 hours before your next dose. Do not double up on your next dose.
Manufacturer
AbbVieAWP
Mavyret (100/40 mg tablets): $15,840 / monthMavyret pack (50/20 mg pellets) (pediatric): $10,184–$20,367 / month based on dose required
Potential Side Effects and Toxicity
Mavyret is a very well-tolerated medication with minimal side effects. In clinical trials, very few people (about 0.1%) discontinued Mavyret due to side effects. Only fatigue and headaches were reported by clinical trial participants at rates higher than 10% (11% and 16%, respectively), with even fewer reporting nausea or diarrhea. Rates of side effects are not affected by treatment duration, presence of cirrhosis, HIV/HCV coinfection, history of kidney transplant, or adolescence. There are no serious lab abnormalities expected. Mavyret has not been studied in in people who are pregnant or nursing, so its impact on fetal development or nursing babies is unknown.
Potential Drug Interactions
Before starting Mavyret, be sure to tell your medical provider or pharmacist about all the medications, supplements and herbal products you take, whether they are prescribed, over-the-counter, or recreational. It is important to report any changes to your medications as they happen during treatment. Mavyret should not be taken with HIV medications that require a booster (ritonavir or cobicistat), such as atazanavir and darunavir, to increase drug levels. Mavyret should not be taken with the HIV medications efavirenz or etravirine. It should also not be taken with rifampin or carbamazepine due to decreased concentrations of both components of Mavyret. Use with certain statins (cholesterol medicine) may cause increased risk of muscle pain (myopathy) or muscle breakdown (rhabdomyolysis). Your doctor should determine if your statin may be continued or changed during treatment with Mavyret. There are no interactions with methadone or other common medications used for opioid, alcohol, or nicotine dependency. Use of ethinyl estradiol (estrogen)-containing birth control (specifically doses greater than 20 mcg per day) is not recommended due to a potential increase in ALT (a liver enzyme). Mavyret should not be used with cyclosporine doses higher than 100 mg daily. It cannot be taken with St. John’s wort; in general, herbal products should be avoided due to lack of information regarding potential for interaction.
More Information
Mavyret is a pangenotypic (active against all 6 genotypes) regimen that cures most people in as few as 8 weeks of treatment. Some people may need to take Mavyret for 12 or 16 weeks, depending on HIV status, previous treatment experience, and presence of cirrhosis. The overall cure rate (sustained virologic response, or SVR) across all genotypes was 97.5%.
Mavyret can be used in several special populations. It is an excellent regimen for people with kidney disease, including people on hemodialysis, curing 98% who had severe kidney disease in 12 weeks of treatment (EXPEDITION-4) as well as for patients who are post-liver or kidney transplant. It is also approved for children aged 3 and older.
NS3/4A protease inhibitors, such as glecaprevir, are not recommended for people with moderate or severe liver impairment (Child-Pugh B/C), which is also called decompensated cirrhosis.
For more information, GO TO hcvguidelines.org.
Black Box Warning
Before starting treatment with any direct-acting antiviral (DAA), including Mavyret, patients should take a blood test to check for hepatitis B (HBV) infection. HBV infection could worsen or reactivate during or after DAA treatment, potentially leading to serious liver problems, including liver failure or death. Patients with current or past HBV infection should be monitored during HCV DAA treatment, and some may need to take HBV treatment. SEE HBV Reactivation for more information and consult your medical provider.