Medical therapy of patients affected by HBeAg-negative chronic hepatitis B.
Five agents are currently approved for the treatment of chronic hepatitis B: standard interferon-alpha (IFN-alpha), pegylated interferon-alpha 2a (PEG-IFN-alpha 2a), lamivudine, adefovir and entecavir. Each agent has inherent limitations. IFN and PEG-IFN-alpha 2a are effective in a minority of patients and have frequent side effects that limit their tolerability. The efficacy of lamivudine is limited by the emergence of drug-resistant hepatitis B virus (HBV) mutants, restricting its utility as a long-term therapy. Adefovir is well tolerated and associated with a low incidence of resistance but its antiviral effect is not optimal. Entecavir, which has been recently registered, has a more potent anti-viral effect but its long term efficacy and resistance profile is still not known. These antivirals induce a sustained response after withdrawal of therapy in only a minority of patients and therefore the treatment needs to be indefinitely administered in the majority of patients. After a brief summary of the natural history of chronic hepatitis B in order to understand the indications and the objectives of therapy, this review focuses on treatment of HBeAg-negative chronic hepatitis B with IFN and PEG-IFN-alpha 2a.
Division of Hepatology and INSERM CRB3, University of Paris VII, Beaujon Hospital, Clichy, France. patrick.marcellin@bjn.ap-hop-paris.fr
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Marcellin
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Boyer
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Asselah
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006513:Hepatitis B e Antigens; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D019259:Lamivudine; D011092:Polyethylene Glycols; C413685:entecavir; D006147:Guanine; D000225:Adenine; C100416:peginterferon alfa-2a; C106812:adefovir dipivoxil