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A fixed-dose combination tablet of the hepatitis C virus (HCV) NS5A inhibitor elbasvir and the HCV NS3/4A protease inhibitor grazoprevir (elbasvir/grazoprevir; Zepatier™) is under development by Merck. Oral elbasvir/grazoprevir 50/100 mg once daily has been approved in the USA for the treatment of adults with chronic HCV genotype 1 or 4 infection. This article summarizes the milestones in the development of elbasvir/grazoprevir leading to this first global approval for chronic HCV genotype 1 or 4 infection.