— Christine M. Kukka, Project Manager, HBV Advocate
Four European experts explain why each chooses
either antivirals or pegylated interferon to treat hepatitis B patients
in a series of articles published in the February 2014 issue of the
journal Liver International.
Under current guidelines,
either antivirals or interferon can be used as a first-line treatment
for hepatitis B. Interferon, which spurs the immune system to fight the
infection, requires a weekly injection over a 48-week period. It is
costly and often accompanied by body aches and flu-like symptoms. In
contrast, antivirals are daily pills that stop the virus from
replicating for as long as the medication is used.
Why I treat my HBeAg-negative patients with pegylated interferon:
Researchers from Athens University Medical School explained why they
prefer interferon to treat this common, but aggressive form of chronic
hepatitis B.
Antivirals are safe, they
admitted, but they must be used long-term, possibly as lifelong
treatment in older people with HBeAg-negative hepatitis B. In contrast, a
48-week treatment with interferon can offer a permanent solution.
About one-fourth of HBeAg-negative patients treated with interferon
eventually clear HBsAg, thus minimizing future liver damage and cancer.
However, interferon is
effective only in patients with certain HBV strains or genotypes.
Longer treatment may improve the odds for those with hard-to-treat
genotypes, but more study is needed.
Why I treat HBeAg-negative patients with antivirals:
Researchers from Italy promoted antiviral treatment—primarily
entecavir and tenofovir—in patients who may not respond to interferon
because of their genotype or its cost.
Long-term antiviral treatment,
they wrote, suppresses HBV replication in more than 95% of patients
after five years. These patients achieve normal, healthy livers, and
even patients with fibrosis and cirrhosis experience dramatic
improvements.
The drawbacks are the long-term
treatment required and the costs associated with lifelong medication
and side effects that may emerge from long-term treatment.
Why I treat HBeAg-positive patients with pegylated interferon:
An expert from the National Taiwan University College of Medicine
acknowledged that while many patients prefer antiviral pills because of
their convenience, "...a finite duration of pegylated interferon
(treatment) is still an attractive strategy."
He noted that interferon continues to boost the
immune system even after the weekly injections end after 48 weeks. "In
addition, the rate of HBeAg/HBsAg loss or seroconversion increases over
time in patients who respond to interferon therapy," he wrote.
"Nevertheless, these benefits are limited to 30% of all patients, and
significant adverse (side) effects are still a concern."
Therefore, doctors should select patients who would
benefit most from interferon based on their age, liver health, viral
load, genotype, and viral mutations. Additionally, they should monitor
patients' viral load, HBsAg levels and HBeAg status after 12 weeks of
interferon treatment to determine if treatment should continue.
"Understanding these factors
can help determine personalized interferon therapy for patients," he
noted. "In the near future, the treatment paradigm of chronic hepatitis
B should be tailored based on HBV DNA level, HBV genotype and HBV
mutants and host (age, gender, ALT level and host genetic polymorphisms)
factors, disease status (fibrosis) and the selection of (appropriate)
antiviral agents…."
Source:
www.ncbi.nlm.nih.gov/pubmed/24373087
Why I treat HBeAg-positive patients with antivirals:
A researcher from Barcelona explained that he uses antivirals in most
HBeAg-positive hepatitis B patients because they are easy-to-take and
can be prescribed to all patients regardless of genotype.
The current leading
antivirals—entecavir and tenofovir—have few side effects and have low
rates of drug resistance. As a result, nearly all HBeAg-positive
patients (who generally have high viral loads) who take them as
prescribed are able to achieve almost undetectable viral loads.
"Tolerance is excellent and the safety profile is good, whereas
interferon can be associated with adverse events that affect the
patients' quality of life," he wrote.
"There is considerable evidence
to show that antivirals modify the natural history of chronic
hepatitis B and increasing evidence that they reduce the risk of liver
cancer," he wrote. "The need for long-term, perhaps indefinite
treatment in patients who do not achieve HBeAg seroconversion (loss of
HBeAg and gaining of the "e" antibody) exists, but this is offset by
their excellent tolerance and safety profile."
Labels: antivirals or interferon?
