Glecaprevir with pibrentasvir

How it works

Glecaprevir inhibits the HCV NS3/4A protease required for viral polyprotein processing, while pibrentasvir inhibits the NS5A protein essential for viral replication and assembly, giving complementary pangenotypic activity.

Prescribing in practice

• It is contraindicated in decompensated (Child-Pugh C) liver disease, and cases of hepatitis B reactivation mean patients should be screened for HBV before starting.
• It is a substrate and inhibitor of P-glycoprotein and BCRP and interacts with statins, certain anticonvulsants, rifampicin and ethinylestradiol-containing products, which must be reviewed.
• Tablets should be taken with food once daily to ensure adequate absorption.

Monitoring

Check hepatitis B status and baseline liver function before treatment, with on-treatment monitoring guided by the degree of underlying liver disease.

Counselling the patient

• Take the tablets with food at the same time each day to complete the short course.
• Tell your prescriber about all other medicines, including statins and any herbal products such as St John's wort.
• Mention any past hepatitis B infection so it can be monitored during treatment.

Evidence & guidelines

Glecaprevir-pibrentasvir is recommended by NICE as a pangenotypic option for chronic hepatitis C, achieving high sustained virological response rates in registration trials.