— Christine M. Kukka, Project Manager, HBV Advocate
Two teams of doctors summarized their preferences in treating HBeAg-positive and HBeAg-negative patients in the January 2015 issue of the journal Liver International.
How do I treat my HBeAg-negative patients? A team from Italy tackled how best to treat this difficult-to-cure phase of hepatitis B and halt viral replication and liver damage.
Two different treatment strategies are currently available: a short-term course of pegylated interferon or long-term antiviral treatment using either entecavir or tenofovir (Viread).
Young patients with mild-to-moderate stages of liver disease can benefit from a 48-week course of interferon, while antivirals may be preferred in older patients, those with severe liver damage or those who haven't responded to interferon or who do not want to endure its flu-like side effects, they wrote.
While antivirals are effective in halting viral replication and further liver damage, it remains unclear whether antivirals prevent liver cancer, they noted.
Also, patients may have to take antivirals for the rest of their lives, can risk development of drug resistance and must pay the high cost of these medications.
"On the other hand, interferon treatment may achieve a sustained viral response in nearly a quarter of patients, ultimately leading to HBsAg loss in almost 30-50%," they wrote.
"Interestingly, response rates to interferon may further increase with more careful patient selection based on age, ALT and HBV DNA levels at baseline and by applying early on-treatment stopping rules based on HBV DNA and HBsAg kinetics," they concluded. (1)
How do I treat HBeAg-positive patients? A team of Greek researchers compared interferon and antiviral treatment for these patients with high viral loads.
Interferon has a limited duration of treatment (about 48 weeks) with a chance of permanent results, they noted.
However, these benefits are limited to approximately 30% of HBeAg-positive patients, and are accompanied by weekly injections and side effects, they wrote.
Candidates who will benefit from interferon must be carefully selected and monitored. New research shows that if patients haven't responded after 12 weeks of interferon treatment, it should be stopped in these non-responders.
The antivirals entecavir and tenofovir will quickly tamp down viral load with a low risk of drug resistance, researchers pointed out, but these too have their drawbacks. Patients may need to take them for many years, and there may be safety concerns in young patients who want to have children.
"Since there will always be safety concerns and family planning issues with long-term therapy, (antivirals) should be used carefully particularly in young HBeAg-positive patients with minimal-mild liver disease," they added. (2)
Labels: antivirals or interferon?
