Current treatment of chronic hepatitis B.
The primary goal of therapy in patients with chronic hepatitis B is suppression and long-lasting maintenance of hepatitis B virus DNA to its lowest possible level. The threshold of hepatitis B virus DNA level for therapy is > or = 10(5) copies/mL for HBeAg-positive patients and > or = 10(4) for those with HBeAg-negative chronic hepatitis B. Interferon alpha-2b, lamivudine, and adefovir-dipivoxil are approved by FDA and could all be used as an initial first-line therapy in chronic hepatitis B. Adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy. Adding lamivudine to adefovir had also no additional effect in compensated patients. Response rate is about 30% - 40% with first-line drugs. Peg-interferon, which recently received the FDA approval, is associated with an increased response rate. Further long-term studies are required to use peg-interferon as a widespread first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent, aiming at eradicating covalently closed circular DNA.
Montazeri
Ghodrat
G
Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran. montazer@ams.ac.ir
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005544:Forecasting; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D019251:Nucleocapsid / Q000627:therapeutic use*; D063065:Organophosphonates / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens; D007155:Immunologic Factors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D011092:Polyethylene Glycols; D000225:Adenine; C100416:peginterferon alfa-2a; C106812:adefovir dipivoxil