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Epclusa Vs Harvoni – Which is better?

Medically reviewed by Carmen Fookes, BPharm Last updated on May 11, 2020.

Official Answer

by Drugs.com
  • Both Epclusa and Harvoni are antiviral medications used for the treatment of hepatitis C. They both contain two antiviral medications per tablet.
  • Both have similar effectiveness. Cure rates of over 95-97% of people have been reported with Epclusa compared with cure rates of 93-95% with Harvoni.
  • Epclusa contains sofosbuvir and velpatasvir and Harvoni contains sofosbuvir and ledipasvir. Sofosbuvir is an antiviral drug that is considered the “backbone” of hepatitis C treatment.
  • Both Epclusa and Harvoni can be given as stand-alone treatments; however, they both need to be given with ribavirin when used to treat people with decompensated cirrhosis.
  • Epclusa is taken for 12 weeks; Harvoni is taken for 12 or 24 weeks, depending on the status of the liver. 
  • The wholesale cost of Epclusa is $930 per tablet and Harvoni costs around $1,175 per tablet. Both are available as generics. Both are taken as a single tablet, once daily. A 12-week treatment course of Epclusa would cost around $78,078 and a 12-week treatment course of Harvoni costs approximately $98,500.
  • Both Epclusa and Harvoni are usually covered by insurance companies or Medicare if certain criteria are met, and Gilead offers a special patient assistance program called Support Path™.
  • Both Epclusa and Harvoni cause few side effects but those that may occur include a headache, fatigue, itching, asthenia (lack of energy), and nausea. Harvoni is also likely to cause cough, myalgia (muscle pains), dyspnea (shortness of breath), insomnia, and diarrhea.

Both Epclusa and Harvoni are antiviral medications used for the treatment of hepatitis C.

Epclusa contains sofosbuvir and velpatasvir and Harvoni contains sofosbuvir and ledipasvir. Sofosbuvir is an antiviral drug that is considered the “backbone” of hepatitis C treatment. Both Epclusa and Harvoni are manufactured by Gilead Sciences.

Which is more effective: Epclusa or Harvoni?

Although both Epclusa and Harvoni are effective for treating hepatitis C, Epclusa may cure a greater percentage of people than Harvoni does. Epclusa was approved in 2016 and was the first medication approved that was effective at treating all six hepatitis C genotypes.

Treatment recommendations issued by the Infectious Disease Society of America recommend:

  • Both Harvoni and Epclusa for hepatitis C genotypes 1, 4, 5, and 6 in adults
  • Epclusa for genotypes 2 and 3
  • Harvoni for treating genotypes 1, 4, 5, and 6 in children ages 12 and older (or weighing 77 pounds and greater).

Studies that involved people with and without cirrhosis found that Epclusa and Harvoni had similar cure rates. Overall, more than 95-97% of people receiving sofosbuvir and velpatasvir (Epclusa) were cured of the virus, compared with 93-95% of people who received sofosbuvir and ledipasvir (Harvoni).

What is the cost of Epclusa and Harvoni?

The cost of Epclusa is approximately $930 for each tablet (400mg/100mg) depending on the pharmacy you visit. This corresponds to an average cost of $26,026 for a 4-week treatment course, $52,052 for an 8-week treatment course, and $78,078 for a 12-week treatment course.

Epclusa is available as a generic, under the name velpatasvir/sofosbuvir. The cost for oral velpatasvir/sofosbuvir tablets (100 mg/400 mg) is around $240 per tablet or 6,729 for a supply of 28, depending on the pharmacy you visit. 

The cost of Harvoni is approximately $1,175 per pill, $65,000 for an 8-week treatment course, $98,500 for a 12-week treatment course, and $197,000 for a 24-week course.

Harvoni is available as a generic, under the name ledipasvir/sofosbuvir. The cost for oral ledipasvir/sofosbuvir tablets (90 mg/400 mg) is around $360 per tablet or $10,090 for a supply of 28, depending on the pharmacy you visit.

Most insurance companies and Medicare cover the cost of Epclusa or Harvoni; however, you may have to meet certain criteria and you should always check with your insurance company first before you and your doctor make it your preferred treatment. There may also be a co-pay.

Gilead, the manufacturer of both Epclusa and Harvoni, has a special patient assistance program called Support Path™ that may assist with co-pay insurance coupons or make Epclusa or Harvoni available at no charge for eligible and qualified uninsured patients insurance who need assistance paying for their out-of-pocket medication costs. To learn more about Support Path, call +1 855 769 72846, Monday through Friday between 9:00 a.m. and 8:00 p.m. (Eastern Time).

If you have no success getting Epclusa of Harvoni at a reduced cost through Gilead’s Support Path, you could try organizations that offer help to people with hepatitis C, such as the American Liver Foundation, Hepatitis Foundation International, or Needy Meds.

What is Epclusa?

Epclusa contains two antiviral ingredients, sofosbuvir and velpatasvir, and may be used to treat chronic hepatitis C in adults and children over the age of six.

Sofosbuvir interferes with the reproduction of genetic material of the hepatitis C virus, by inhibiting an RNA-dependent polymerase called HCV NS5B, which is also needed by the virus to replicate itself. Sofosbuvir is a prodrug, which means it is metabolized in the body to its active component and incorporated into the DNA of the HCV virus. Sofosbuvir also works directly on viral RNA and does not inhibit human DNA or RNA.

Velpatasvir is an NS5A (hepatitis C virus nonstructural protein 5A) inhibitor. Velpatasvir works by interfering with a protein, called HCV NS5A that is needed by the virus to replicate itself. This protein is the main target for velpatasvir, meaning velpatasvir works directly on the virus, not on human cells.

What is Harvoni?

Harvoni contains ledipasvir and sofosbuvir.

Ledipasvir is an NS5A (hepatitis C virus nonstructural protein 5A) inhibitor and sofosbuvir is an NS5B (hepatitis C virus nonstructural protein 5B) nucleotide polymerase inhibitor. Ledipasvir works by interfering with a protein, called HCV NS5A that is needed by the virus to replicate itself. This protein is the main target for ledipasvir, which is one of the reasons Harvoni has few side effects, as ledipasvir works directly on the virus, not on human cells.

Sofosbuvir interferes with the reproduction of genetic material of the hepatitis C virus, by inhibiting an RNA-dependent polymerase called HCV NS5B, which is also needed by the virus to replicate itself. Sofosbuvir is actually a prodrug, which means it is metabolized in the body to its active component and incorporated into the DNA of the HCV virus. Sofosbuvir also works directly on viral RNA and does not inhibit human DNA or RNA.

The ingredients in Harvoni initially greatly reduce and then completely stop the production of new copies of the hepatitis C virus. After a period of time, Harvoni will eliminate the hepatitis C virus in 95% of people who take it, technically curing them. A cure is defined as a lack of detection of the hepatitis C virus in the blood for 12 weeks. However, a person can become reinfected with the hepatitis C virus if they are exposed to it again.

Harvoni prevents the hepatitis C virus (HCV) from multiplying in the body. It is a single combination pill that is given by mouth once a day for 8, 12, or 24 weeks, depending upon your HCV status.

What are the side effects of Epclusa and Harvoni?

Since Epclusa and Harvoni contain similar antiviral medications, the side effects are similar.

The most common Epclusa side effects occurring in 10% or more of patients are:

  • Anemia
  • Diarrhea
  • Headache
  • Fatigue
  • Insomnia
  • Itching
  • Asthenia (lack of energy)
  • Nausea.

In addition, reactivation of hepatitis B has been reported in people who have a current or prior hepatitis B virus (HBV) infection before initiating treatment with Epclusa. In some cases, this has resulted in severe and rapid liver disease, hepatic failure, and death.

The most common side effects reported with Harvoni are:

  • Asthenia (lack of energy)
  • Headache
  • Fatigue
  • Cough
  • Myalgia (muscle pains)
  • Dyspnea (shortness of breath)
  • Irritability
  • Dizziness
  • Nausea
  • Insomnia
  • Diarrhea.

Just like Epclusa, reactivation of hepatitis B has been reported in people who have a current or prior hepatitis B virus (HBV) infection before initiating treatment with Harvoni. In some cases, this has resulted in severe and rapid liver disease, hepatic failure, and death.

 

References
  • Epclusa (velpatasvir and sofosbuvir) Gilead Sciences, Inc. https://www.drugs.com/pro/epclusa.html
  • Harvoni [Package Insert] 11/2019 Gilead Sciences, Inc https://www.drugs.com/pro/harvoni.html

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