Review article: current antiviral therapy of chronic hepatitis B

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04869.x/abstract

Review article: current antiviral therapy of chronic hepatitis B

W. S. Ayoub, E. B. Keeffe

Article first published online: 7 OCT 2011

DOI: 10.1111/j.1365-2036.2011.04869.x

© 2011 Blackwell Publishing Ltd

Issue

Alimentary Pharmacology & Therapeutics

Early View (Online Version of Record published before inclusion in an issue)

Summary

Background  The indications and endpoints for treatment of chronic hepatitis B

continue to evolve. The aim of the therapy for chronic hepatitis B is to achieve

a long-term continued suppression of the hepatitis B virus (HBV) DNA to prevent

disease progression leading to the development of cirrhosis and hepatocellular

carcinoma.

Aim  To summarise current literature on therapy of chronic hepatitis B, with a

focus on indications for therapy, preferred treatment options, and management of

resistance and partial responders.

Methods  A systematic review of the literature, with a focus on international

guidelines, was performed.

Results  Seven drugs are licensed for the treatment of chronic hepatitis B in

many countries. The selection of a drug with high potency and low rate of

resistance is essential to achieve rapid and long-term viral suppression. The

prevention of the sequelae of antiviral drug resistance and appropriate

management of viral breakthrough are major goals of current management. The

addition or change to an antiviral agent that is not cross-resistant is critical

to restore suppression of viral replication for patients with breakthrough

resistance. Patient adherence to medication is essential to achieve adequate HBV

DNA suppression.

Conclusions  The current treatment strategy of chronic hepatitis B is now

standard: initial selection of entecavir, tenofovir, or peginterferon alfa-2a.

Future studies are required to determine if combination therapy using two oral

agents or peginterferon with an oral agent with a high genetic barrier to

resistance might be superior to standard current monotherapy.