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

[Guest guest]

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

ssionid=3A4BA745B598493EA58D093693CEDF7C.d02t02

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

Volume 33, Issue 5, pages 501–513, March 2011

Aliment Pharmacol Ther 2011; 33: 501–513

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.

[Guest guest]

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

ssionid=3A4BA745B598493EA58D093693CEDF7C.d02t02

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

Volume 33, Issue 5, pages 501–513, March 2011

Aliment Pharmacol Ther 2011; 33: 501–513

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.