Synthesis of Grazoprevir, a Potent NS3/4A Protease Inhibitor for the Treatment of Hepatitis C Virus Synthesis of Natural Org

Total Page:16

File Type:pdf, Size:1020Kb

Synthesis of Grazoprevir, a Potent NS3/4A Protease Inhibitor for the Treatment of Hepatitis C Virus Synthesis of Natural Org F. XU*, J. KIM, J. WALDMAN, T. WANG, P. DEVINE (MERCK & CO., INC., RAHWAY, USA) Category Synthesis of Grazoprevir, a Potent NS3/4a Protease Inhibitor for the Treatment of Hepatitis C Virus Synthesis of Natural Org. Lett. 2018, 20, 7261–7265. Products and Potential Drugs Synthesis of Grazoprevir Key words grazoprevir NS3/4a protease HO inhibitor MeO O MeO O NH O macrolactamization Boc O O N ⋅t-BuNH NH 2 Sonogashira ⋅MsOH reaction HO 95:5 regioselectivity MeO N Cl B (1.1 equiv) D (1.05 equiv) MeO N O DBU (1.3 equiv) CuI (0.01 equiv) N Cl DMA, 45 °C, 35 h (PPh3)3PdCl2 (0.005 equiv) A then MsOH (1.3 equiv) N Cl DIPEA (2.0 equiv) MeCN, 40 °C, 16 h C MeOH, 35 °C, 5 h 78% (437 mmol scale) mp not reported 115 mmol scale MeO O MeO O O N NH ⋅MsOH HATU (1.5 equiv) HO NH DIPEA (1.0 equiv) NH MeO N O MeO N O O O O DMAc–THF, 0 °C, 7 h O O 84% from C N N F mp not reported E mp not reported 1. H2 (50 psi), 5% Pd/C THF, 30 °C 87% (18 mmol scale) 2. NaOH (2.25 equiv) MeOH, 45 °C, 4 h 96% (158 mmol scale) O O O O O O H HO O S NH2⋅HOTs S N O O N N O H H N N ⋅0.5 H2O HN O H (1.1 equiv) HN O MeO N O O EDC⋅HCl (1.3 equiv) MeO N O O THF, 15 °C, 3 h 94% (18 mmol scale) N N G Grazopravir mp not reported mp not reported Significance: Grazoprevir is an NS3/4a protease Comment: The thermal instability of the free base This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. inhibitor. It was approved by the FDA in 2016 as a of alkyne D was a challenge in the Sonogashira re- combination drug with elbasvir (Zepatier®) for the action. By using methanol as solvent, catalyst sta- treatment of hepatitis C viral infections. The scheme bility and reactivity was improved as evinced by in- depicts the chemistry developed to conjoin the creased catalytic turnover at milder temperatures fragments A, B, D, and H on large scale (>100 kg) (35 °C). The free base of sulfonamide H was unsta- in 51% overall yield and >99.8% purity. ble at ambient temperature. Therefore, the EDC coupling was conducted at 0 °C by adding pyridine to a slurry of the acid G and the PTSA salt H in THF. SYNFACTS Contributors: Philip Kocienski Synfacts 01022019, 15(02), 0111 Published online: 18.01.20191861-19581861-194X DOI: 10.1055/s-0037-1612028; Reg-No.: K07718SF ©Georg Thieme Verlag Stutgart · New York 2019 © Georg Thieme Verlag Stuttgart · New York 111.
Recommended publications
  • Hepatitis C Agents Therapeutic Class Review
    Hepatitis C Agents Therapeutic Class Review (TCR) November 2, 2018 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. Proprietary Information. Restricted Access – Do not disseminate or copy without approval. © 2004–2018 Magellan Rx Management. All Rights Reserved. FDA-APPROVED INDICATIONS Drug Mfr FDA-Approved Indications Interferons peginterferon alfa-2a Genentech Chronic hepatitis C (CHC) 1 (Pegasys®) .
    [Show full text]
  • Sofosbuvir-Based and Elbasvir/Grazoprevir Treatment Fai
    Sofosbuvir-Based and Elbasvir/Grazoprevir Treatment Fai... From www.HCVGuidance.org on September 27, 2021 Sofosbuvir-Based and Elbasvir/Grazoprevir Treatment Failures In general, persons who have experienced treatment failure with a sofosbuvir-based regimen should be retreated with 12 weeks of sofosbuvir/velpatasvir/voxilaprevir. The main exception is persons with genotype 3 and cirrhosis, in whom addition of ribavirin to sofosbuvir/velpatasvir/voxilaprevir for 12 weeks is recommended. Sixteen weeks of glecaprevir/pibrentasvir is an alternative regimen. Elbasvir/grazoprevir treatment failure patients should also be retreated with 12 weeks of sofosbuvir/velpatasvir/voxilaprevir. However, glecaprevir/pibrentasvir for 16 weeks is not recommended as an alternative for this group of patients. Recommended and alternative regimens listed by evidence level and alphabetically for: Sofosbuvir-Based Treatment Failures, With or Without Compensated Cirrhosisa RECOMMENDED DURATION RATING Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 12 weeks I, A mg)/voxilaprevir (100 mg)b ALTERNATIVE DURATION RATING Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg) 16 weeks I, A except for NS3/4 protease inhibitor inclusive combination DAA regimen failuresc Not recommended for genotype 3 infection with sofosbuvir/NS5A inhibitor experience. a For decompensated cirrhosis, please refer to the appropriate section. b Genotype 3: Add weight-based ribavirin if cirrhosis is present and there are no contraindications. c This regimen is not recommended for patients with prior exposure to an NS5A inhibitor plus NS3/4 PI regimens (eg. Elbasvir/grazoprevir). Recommended Regimen Sofosbuvir/Velpatasvir/Voxilaprevir The placebo-controlled, phase 3 POLARIS-1 trial evaluated a 12-week course of the daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100mg) in 263 persons with a prior NS5A inhibitor-containing DAA regimen failure.
    [Show full text]
  • Grazoprevir/Elbasvir Plus Ribavirin for Chronic HCV Genotype-1 Infection After Failure of Combination Therapy Containing a Direct-Acting Antiviral Agent
    Accepted Manuscript Grazoprevir/Elbasvir plus Ribavirin For Chronic HCV Genotype-1 Infection After Failure of Combination Therapy Containing a Direct-Acting Antiviral Agent Xavier Forns, Stuart C. Gordon, Eli Zuckerman, Eric Lawitz, Jose L. Calleja, Harald Hofer, Christopher Gilbert, John Palcza, Anita Y.M. Howe, Mark J. DiNubile, Michael N. Robertson, Janice Wahl, Eliav Barr, Maria Buti PII: S0168-8278(15)00291-3 DOI: http://dx.doi.org/10.1016/j.jhep.2015.04.009 Reference: JHEPAT 5646 To appear in: Journal of Hepatology Received Date: 6 March 2015 Revised Date: 31 March 2015 Accepted Date: 16 April 2015 Please cite this article as: Forns, X., Gordon, S.C., Zuckerman, E., Lawitz, E., Calleja, J.L., Hofer, H., Gilbert, C., Palcza, J., Howe, A.Y.M., DiNubile, M.J., Robertson, M.N., Wahl, J., Barr, E., Buti, M., Grazoprevir/Elbasvir plus Ribavirin For Chronic HCV Genotype-1 Infection After Failure of Combination Therapy Containing a Direct-Acting Antiviral Agent, Journal of Hepatology (2015), doi: http://dx.doi.org/10.1016/j.jhep.2015.04.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Grazoprevir/Elbasvir plus Ribavirin For Chronic
    [Show full text]
  • Treatment of HCV in Persons with Renal Impairment
    © Hepatitis C Online PDF created September 29, 2021, 2:18 pm Treatment of HCV in Persons with Renal Impairment This is a PDF version of the following document: Module 6: Treatment of Key Populations and Unique Situations Lesson 3: Treatment of HCV in Persons with Renal Impairment You can always find the most up to date version of this document at https://www.hepatitisC.uw.edu/go/key-populations-situations/treament-renal-impairment/core-concept/all. Background Epidemiology of Hepatitis C Infection and Renal Disease Persons infected with hepatitis C virus (HCV) can develop kidney disease as a result of extrahepatic manifestation of HCV or as a disease process independent of the HCV infection. In addition, hemodialysis has been a risk factor for acquiring HCV infection, as shown by numerous outbreaks and HCV cross-infections that have occurred in hemodialysis units.[1,2,3,4] Earlier studies conducted in western countries have shown an HCV prevalence in hemodialysis patients that ranged from 2.6 to 23%, with higher prevalence correlating with longer duration of hemodialysis.[5,6,7] The risk of HCV transmission in hemodialysis units has declined due to improved testing and infection control practices.[8,9] Interaction of Hepatitis C Infection and Renal Disease Several studies have shown that patients on chronic hemodialysis have an increased overall mortality risk if they have chronic hepatitis C infection (when compared with those on dialysis who do not have hepatitis C infection).[10,11] There are also some data showing that chronic hepatitis C may be a risk factor for developing renal cell carcinoma.[12] Chronic hepatitis C infection has also been associated with an accelerated course of renal disease, including in persons with HIV coinfection.[13,14] Extrahepatic manifestations related to HCV, including immune complex-related renal disease, can require urgent HCV treatment to resolve or prevent further organ damage.
    [Show full text]
  • Elbasvir/Grazoprevir for Hepatitis C Virus Genotype 1B East-Asian Patients Receiving Hemodialysis
    www.nature.com/scientificreports OPEN Elbasvir/grazoprevir for hepatitis C virus genotype 1b East-Asian patients receiving hemodialysis Chen-Hua Liu 1,2,3, Cheng-Yuan Peng 4,5, Yu-Jen Fang3, Wei-Yu Kao 6,7,8, Sheng-Shun Yang9,10,11,12,13, Cheng-Kuan Lin14, Hsueh-Chou Lai4,5, Wen-Pang Su5, Sheng-Uei Fang6,7, Chun-Chao Chang6,7,8, Tung-Hung Su 1,2, Chun-Jen Liu 1,2, Pei-Jer Chen1,2,15, Ding-Shinn Chen1,2,16 & Jia-Horng Kao 1,2,15 ✉ Data regarding the efcacy and tolerability of elbasvir/grazoprevir (EBR/GZR) for East-Asian hepatitis C virus genotype 1b (HCV GT1b) patients receiving hemodialysis were limited. We prospectively recruited 40 HCV GT1b hemodialysis patients who received EBR/GZR for 12 weeks at 6 academic centers in Taiwan. The efcacy endpoints were sustained virologic response 12 weeks of-therapy (SVR12) by intention-to-treat (ITT) modifed ITT (mITT) analyses. Patients’ baseline characteristics, early viral kinetics and HCV resistance-associated substitutions (RASs) at HCV non-structural 3 and 5 A (NS3 and NS5A) regions potentially afecting SVR12 were analyzed. The tolerability for EBR/GZR was also assessed. The SVR12 rates by ITT and mITT analyses were 95% (38 of 40 patients; 95% confdence interval (CI): 83.5–98.6%) and 100% (38 of 38 patients; 95% CI: 90.8–100%), respectively. Patients’ baseline characteristics, on-treatment viral decline, and baseline HCV RASs did not afect SVR12. All patients tolerated treatment well. Among 5 patients who had serious adverse events (AEs) including one death due to on-treatment suicide and the other death due to of-therapy acute myocardial infarction, none of these events were judged related to EBR/GZR.
    [Show full text]
  • Review of the Grazoprevir Patent Landscape: a Scoping Report
    2015 Review of the Grazoprevir Patent Landscape: A scoping report JULY 2015 UNITAID Secretariat World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland T +41 22 791 55 03 F +41 22 791 48 90 [email protected] www.unitaid.org UNITAID is hosted and administered by the World Health Organization © 2015 World Health Organization (Acting as the host organization for the Secretariat of UNITAID) The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. This report was prepared by Andrew Brown and Amel Garbi (Pharmathen) with input from Karin Timmermans (UNITAID). All reasonable precautions have been taken by the authors and the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall UNITAID or the World Health Organization be liable for damages arising from its use. CONTENTS Abbreviations . iv I. INTRODUCTION . 1 II. METHODOLOGY. 2 III. BACKGROUND . 3 Hepatitis C virus . 3 Grazoprevir.
    [Show full text]
  • Caracterización Molecular Del Perfil De Resistencias Del Virus De La
    ADVERTIMENT. Lʼaccés als continguts dʼaquesta tesi queda condicionat a lʼacceptació de les condicions dʼús establertes per la següent llicència Creative Commons: http://cat.creativecommons.org/?page_id=184 ADVERTENCIA. El acceso a los contenidos de esta tesis queda condicionado a la aceptación de las condiciones de uso establecidas por la siguiente licencia Creative Commons: http://es.creativecommons.org/blog/licencias/ WARNING. The access to the contents of this doctoral thesis it is limited to the acceptance of the use conditions set by the following Creative Commons license: https://creativecommons.org/licenses/?lang=en Programa de doctorado en Medicina Departamento de Medicina Facultad de Medicina Universidad Autónoma de Barcelona TESIS DOCTORAL Caracterización molecular del perfil de resistencias del virus de la hepatitis C después del fallo terapéutico a antivirales de acción directa mediante secuenciación masiva Tesis para optar al grado de doctor de Qian Chen Directores de la Tesis Dr. Josep Quer Sivila Dra. Celia Perales Viejo Dr. Josep Gregori i Font Laboratorio de Enfermedades Hepáticas - Hepatitis Víricas Vall d’Hebron Institut de Recerca (VHIR) Barcelona, 2018 ABREVIACIONES Abreviaciones ADN: Ácido desoxirribonucleico AK: Adenosina quinasa ALT: Alanina aminotransferasa ARN: Ácido ribonucleico ASV: Asunaprevir BOC: Boceprevir CCD: Charge Coupled Device CLDN1: Claudina-1 CHC: Carcinoma hepatocelular DAA: Antiviral de acción directa DC-SIGN: Dendritic cell-specific ICAM-3 grabbing non-integrin DCV: Daclatasvir DSV: Dasabuvir
    [Show full text]
  • Product Information for Grazoprevir / Elbasvir
    Attachment 1: Product information for AusPAR Zepatier Grazoprevir /Elbasvir Merck Sharp and Dohme (Australia) Pty Limited PM-2015-02428-1-2 15 May 2017 This Product Information was approved at the time this AusPAR was published. 1 PRODUCT INFORMATION ZEPATIER elbasvir / grazoprevir tablets NAME OF THE MEDICINE ZEPATIER (elbasvir / grazoprevir) Elbasvir: Elbasvir has the following structural formula: CAS registry number: 1370468-36-2 Elbasvir has the following chemical name: Dimethyl N,N′-([(6S)-6-phenylindolo[1,2- c][1,3]benzoxazine-3,10-diyl]bis{1H-imidazole-5,2-diyl-(2S)-pyrrolidine-2,1-diyl[(2S)-3-methyl-1- oxobutane-1,2-diyl]})dicarbamate. It has a molecular formula of C49H55N9O7 and a molecular weight of 882.02. Grazoprevir: Grazoprevir has the following structural formula: CAS registry number: 1350514-68-9 Grazoprevir has the following chemical name: (1aR,5S,8S,10R,22aR)-N-[(1R,2S)-1- [(Cyclopropylsulfonamido)carbonyl]-2-ethenylcyclopropyl]-14-methoxy-5-(2-methylpropan-2-yl)- CCDS-MK-5172A-T-022016 Attachment 1: Product information for AusPAR Zepatier Grazoprevir /Elbasvir Merck Sharp and Dohme (Australia) Pty Limited PM-2015-02428-1-2 15 May 2017 This Product Information was approved at the time this AusPAR was published. 2 3,6-dioxo-1,1a,3,4,5,6,9,10,18,19,20,21,22,22a-tetradecahydro-8H-7,10- methanocyclopropa[18,19][1,10,3,6]dioxadiazacyclononadecino[11,12-b]quinoxaline-8- carboxamide. It has a molecular formula of C38H50N6O9S and a molecular weight of 766.90. DESCRIPTION ZEPATIER is a fixed-dose combination tablet containing elbasvir and grazoprevir for oral administration.
    [Show full text]
  • HCV Medications
    HCV Medications OVERVIEW Hepatitis C virus (HCV) infection causes liver inflammation that can lead to liver problems, including cancer. People who have chronic HCV need medication to treat it. HCV drugs can help clear the virus from the body and ease symptoms. Even if an HCV infection hasn’t caused symptoms yet, it’s still important to treat it. This is because drugs can also lower the risk of complications from HCV, such as dangerous liver problems. HCV has different genetic variationsgenotypes ( ). The medication prescribed for HCV depends on the genotype a person has. Genotype 1 is the most common type in the U.S. Here are the medications available to treat HCV, plus some helpful information about what to expect with their treatment. Read more about U.S HCV therapy guidelines, including simplified treatment regimens that cover all genotypes. DIRECT ACTING ANTIVIRALS (DAAs) Direct-acting antivirals (DAAs) are currently the standard of care for chronic HCV infection. These drugs work by attacking HCV directly, which means they’re more targeted than older treatments such as interferons (see below). Additionally, they don’t affect as many systems in the body as interferons, so they may not cause as many side effects. All DAAs are oral drugs. Side effects of DAAs can include: anemia diarrhea fatigue headaches nausea vomiting slow heartbeat grazoprevir Grazoprevir is an HCV protease inhibitor. Protease inhibitors work by stopping viruses from multiplying. Grazoprevir has good activity against a range of HCV genotypes, including some that are resistant to most currently used DAAs. It’s only available in combination with elbasvir and sold as grazoprevir/elbasvir (Zepatier) [see below].
    [Show full text]
  • Hepatitis C Virus Drugs Simeprevir and Grazoprevir Synergize With
    bioRxiv preprint doi: https://doi.org/10.1101/2020.12.13.422511; this version posted December 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 Hepatitis C Virus Drugs Simeprevir and Grazoprevir Synergize with 2 Remdesivir to Suppress SARS-CoV-2 Replication in Cell Culture 3 Khushboo Bafna1,#, Kris White2,#, Balasubramanian Harish3, Romel Rosales2, 4 Theresa A. Ramelot1, Thomas B. Acton1, Elena Moreno2, Thomas Kehrer2, 5 Lisa Miorin2, Catherine A. Royer3, Adolfo García-Sastre2,4,5,*, 6 Robert M. Krug6,*, and Gaetano T. Montelione1,* 7 1Department of Chemistry and Chemical Biology, and Center for Biotechnology and 8 Interdisciplinary Sciences, Rensselaer Polytechnic Institute, Troy, New York, 12180 9 USA. 10 11 2Department of Microbiology, and Global Health and Emerging Pathogens Institute, 12 Icahn School of Medicine at Mount Sinai, New York, NY10029, USA. 13 14 3Department of Biology, and Center for Biotechnology and Interdisciplinary Sciences, 15 Rensselaer Polytechnic Institute, Troy, New York, 12180 USA. 16 17 4Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at 18 Mount Sinai, New York, NY 10029, USA. 19 20 5The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 21 10029, USA 22 23 6Department of Molecular Biosciences, John Ring LaMontagne Center for Infectious 24 Disease, Institute for Cellular and Molecular Biology, University of Texas at Austin, 25
    [Show full text]
  • Drug Consumption at Wholesale Prices in 2017 - 2020
    Page 1 Drug consumption at wholesale prices in 2017 - 2020 2020 2019 2018 2017 Wholesale Hospit. Wholesale Hospit. Wholesale Hospit. Wholesale Hospit. ATC code Subgroup or chemical substance price/1000 € % price/1000 € % price/1000 € % price/1000 € % A ALIMENTARY TRACT AND METABOLISM 321 590 7 309 580 7 300 278 7 295 060 8 A01 STOMATOLOGICAL PREPARATIONS 2 090 9 1 937 7 1 910 7 2 128 8 A01A STOMATOLOGICAL PREPARATIONS 2 090 9 1 937 7 1 910 7 2 128 8 A01AA Caries prophylactic agents 663 8 611 11 619 12 1 042 11 A01AA01 sodium fluoride 610 8 557 12 498 15 787 14 A01AA03 olaflur 53 1 54 1 50 1 48 1 A01AA51 sodium fluoride, combinations - - - - 71 1 206 1 A01AB Antiinfectives for local oral treatment 1 266 10 1 101 6 1 052 6 944 6 A01AB03 chlorhexidine 930 6 885 7 825 7 706 7 A01AB11 various 335 21 216 0 227 0 238 0 A01AB22 doxycycline - - 0 100 0 100 - - A01AC Corticosteroids for local oral treatment 113 1 153 1 135 1 143 1 A01AC01 triamcinolone 113 1 153 1 135 1 143 1 A01AD Other agents for local oral treatment 49 0 72 0 104 0 - - A01AD02 benzydamine 49 0 72 0 104 0 - - A02 DRUGS FOR ACID RELATED DISORDERS 30 885 4 32 677 4 35 102 5 37 644 7 A02A ANTACIDS 3 681 1 3 565 1 3 357 1 3 385 1 A02AA Magnesium compounds 141 22 151 22 172 22 155 19 A02AA04 magnesium hydroxide 141 22 151 22 172 22 155 19 A02AD Combinations and complexes of aluminium, 3 539 0 3 414 0 3 185 0 3 231 0 calcium and magnesium compounds A02AD01 ordinary salt combinations 3 539 0 3 414 0 3 185 0 3 231 0 A02B DRUGS FOR PEPTIC ULCER AND 27 205 5 29 112 4 31 746 5 34 258 8
    [Show full text]
  • Zepatier (Elbasvir + Grazoprevir)
    Zepatier (elbasvir + FACT grazoprevir) SHEET Published 2019 Summary Zepatier is a direct-acting antiviral medication used to treat hepatitis C. It is a combination of two medications, elbasvir CONTACT US and grazoprevir. These two medications are co-formulated into one tablet. Zepatier is approved in Canada for the treatment by telephone of chronic hepatitis C in people over the age of 18 years with 1-800-263-1638 genotype 1, 3 or 4 of the hepatitis C virus. It is taken once a 416-203-7122 day with or without food, for eight, 12 or 16 weeks. Zepatier by fax has few side effects. Common side effects are generally mild 416-203-8284 and temporary; they include fatigue and headache. Direct- acting antivirals are highly effective and cure over 95% of by e-mail people with hepatitis C. [email protected] by mail What is Zepatier? 555 Richmond Street West Suite 505, Box 1104 Zepatier is a direct-acting antiviral medication used to treat hepatitis C. It Toronto ON M5V 3B1 is a combination of two direct-acting antivirals: elbasvir, which is an NS5A (hepatitis C virus non-structural protein 5A) inhibitor and grazoprevir, which is a protease inhibitor. Zepatier is approved in Canada for the treatment of chronic hepatitis C in people over the age of 18 years with genotype 1 and 4 of the hepatitis C virus. Zepatier is also approved in Canada to treat genotype 3 of the hepatitis C virus if it is used in combination with sofosbuvir (Sovaldi), another direct-acting antiviral. How does Zepatier work? Zepatier directly blocks the ability of the hepatitis C virus to make copies of itself in the liver.
    [Show full text]