Chronic hepatitis B: a critical appraisal of current approaches to therapy.
OBJECTIVE
Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature.


METHODS
A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups.


RESULTS
With the exception of 2 statements, the experts' responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas.


CONCLUSIONS
Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.
Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA. rperrillo@ochsner.org
Robert P
RP
Perrillo
Robert G
RG
Gish
Marion
M
Peters
Emmet B
EB
Keeffe
Alfredo
A
Alberti
Maria
M
Buti
W Graham E
WG
Cooksley
Michael W
MW
Fried
Stephanos J
SJ
Hadziyannis
Yun-Fan
YF
Liaw
Nikolai V
NV
Naoumov
Eugene R
ER
Schiff
Chloe L
CL
Thio
Naoky
N
Tsai
Solko
S
Schalm
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D002983:Clinical Competence; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage; D008099:Liver / Q000473:pathology; D063065:Organophosphonates / Q000008:administration & dosage; D018579:Patient Selection; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011994:Recombinant Proteins; D012955:Societies, Medical; D014779:Virus Replication
D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C053001:adefovir; D007372:Interferons; D000410:Alanine Transaminase; D000225:Adenine; C100416:peginterferon alfa-2a