Glecaprevir / Pibrentasvir

How it works

Glecaprevir inhibits the HCV NS3/4A protease and pibrentasvir inhibits the NS5A protein, together blocking viral RNA replication and virion assembly across all major genotypes.

Prescribing in practice

• Contraindicated in decompensated (Child-Pugh C) hepatic impairment and not recommended in Child-Pugh B, owing to a risk of hepatic decompensation and increased exposure.
• Screen for hepatitis B before starting, as HBV reactivation has been reported during and after direct-acting antiviral therapy.
• Numerous drug interactions occur, including with certain statins, ethinylestradiol-containing products and strong P-glycoprotein/CYP3A inducers, so review concomitant medicines against the SPC.

Monitoring

Assess hepatitis B status and baseline liver function before treatment, and monitor for HBV reactivation and confirm cure with a sustained virological response test after completing the course.

Counselling the patient

• Take the tablets with food at the same time each day and do not miss doses, as adherence is important for cure.
• Tell your team about all other medicines, including any bought over the counter or herbal remedies, before and during treatment.

Evidence & guidelines

Pangenotypic direct-acting antiviral regimens are recommended by NICE and have achieved high sustained virological response rates across hepatitis C genotypes in registration trials.