title: Pharmacotherapeutic options for hepatitis B.
abstract: BACKGROUND
  Hepatitis B virus (HBV) is the driving force of disease progression in chronic hepatitis B. Patients with active HBV replication and/or significant liver disease require timely treatment. Currently, pegylated interferon-α (PEG IFN), entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are the preferred first-line drugs.
  
  
  METHODS
  A finite course IFN-based therapy has modest response and may reduce cirrhosis or hepatocellular carcinoma development. Nucleos(t)ide analogs (Nuc) have excellent safety profile, cumulative or maintained response and long-term efficacy in terms of reduction or reversal of fibrosis, decrease in development of cirrhosis and its adverse sequalae. The optimal duration of Nuc therapy is unknown and a feasible stopping rule with off-therapy monitoring plan has been developed.
  
  
  CONCLUSIONS
  Choosing a drug to initiate therapy in a right patient at a right time should be primarily based on the prospect and likelihood for improved outcomes. Nuc is the only choice for patients with hepatic decompensation, pregnant women and those about to receive immune/chemotherapy or organ transplantation. IFN-based therapy is preferred in patients with compensated liver disease, particularly in young patients, females of childbearing age. The development of new drugs and new strategies is the highest priority in further improving the outcomes of treatment.
authors.affiliation: a Liver Research Unit, Chang Gung Memorial Hospital , Chang Gung University College of Medicine , Taipei , Taiwan.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chen
authors.affiliation: a Liver Research Unit, Chang Gung Memorial Hospital , Chang Gung University College of Medicine , Taipei , Taiwan.
authors.forename: Yun-Fan
authors.initials: YF
authors.lastname: Liaw
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000209:etiology; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000209:etiology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000209:etiology; D009705:Nucleosides / Q000627:therapeutic use; D009711:Nucleotides / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009705:Nucleosides; D009711:Nucleotides
keywords: Chronic hepatitis B; cirrhosis; entecavir; pegylated interferon alfa; tenofovir disoproxil fumarate