Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04555.x/abstract;jse\

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Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?

V. Rijckborst, M. J. Sonneveld, H. L. A. JanssenArticle first published online:

29 DEC 2010

DOI: 10.1111/j.1365-2036.2010.04555.x

© 2010 Blackwell Publishing Ltd

Issue

Alimentary Pharmacology & Therapeutics

Early View (Articles online in advance of print)

Summary

Background  First-line treatment options for chronic hepatitis B (CHB) consist

of nucleos(t)ide analogues with a high barrier to resistance (entecavir and

tenofovir) or the immunomodulatory agent peginterferon (PEG-IFN). The optimal

choice for individual patients remains controversial.

Aim  To review treatment options for CHB, with a focus on deciding between

prolonged nucleos(t)ide analogue therapy or a finite course of PEG-IFN.

Methods  A comprehensive literature search was undertaken.

Results  Long-lasting, treatment-maintained suppression of hepatitis B virus

(HBV) DNA without resistance is achievable in most patients by entecavir or

tenofovir. A sustained off-treatment response is, however, unlikely and

long-term therapy must be anticipated. PEG-IFN offers a higher rate of sustained

response in a subgroup of patients, but is frequently complicated by side

effects. Pre-treatment predictors of response, including HBV genotype, alanine

aminotransferase and HBV DNA levels, aid in selecting patients for PEG-IFN

therapy. Furthermore, on-treatment markers such as quantitative hepatitis B

surface antigen may be applied to identify nonresponders early during the

PEG-IFN treatment course, thereby preventing unnecessary treatment.

Conclusions  Both nucleos(t)ide analogues and PEG-IFN can be prescribed as

first-line treatment options for CHB. However, PEG-IFN should only be considered

for patients with a high chance of response based on pre-treatment and

on-treatment factors.