[Entecavir - options and obstacles of an effective treatment for chronic hepatitis B].
The level of HBV-DNA is a crucial determinant of the progression to liver cirrhosis or hepatocellular carcinoma. Thus the effective suppression of HBV-DNA below the limit of detection of high sensitive assays is a major aim of treatment. This aim will be achieved in almost all patients with current available direct antiviral drugs. However, the development of drug resistance remains a main challenge for the future. Entecavir has a good profile regarding both antiviral efficacy and resistance profile in the treatment of previously untreated patients. After five year on Entecavir more than 90 % of HBe-Ag positive patients had achieved HBV-DNA below 300 copies/ml and resistance developed in only about 1 %. However, patients in whom there had been previous resistance to lamivudine have lower treatment responses and higher resistance rates because only one or two additional mutations in the HBV-polymerase gene are required for the development of entecavir resistance in contrast to three mutations required in treatment naïve patients. In summary, Entecavir adds a new milestone in the treatment of chronic hepatitis B.
Cornberg
M
M
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule, Hannover, Carl-Neuberg Strasse 1, 30625 Hannover. cornberg.markus@mh-hannover.de
Manns
M P
MP
D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004351:Drug Resistance; D006147:Guanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology
D000956:Antigens, Viral; D000998:Antiviral Agents; C413685:entecavir; D006147:Guanine