Background
First-line treatment options for chronic hepatitis B (CHB) consist of
nucleos(t)ide analogues with a high barrier to resistance (entecavir and
tenofovir) or the immunomodulatory agent peginterferon (PEG-IFN). The optimal
choice for individual patients remains controversial.
Aim
To review treatment options for CHB, with a focus on deciding between prolonged
nucleos(t)ide analogue therapy or a finite course of PEG-IFN.
Methods
A comprehensive literature search was undertaken.
Results
Long-lasting, treatment-maintained suppression of hepatitis B virus (HBV) DNA
without resistance is achievable in most patients by entecavir or tenofovir. A
sustained off-treatment response is, however, unlikely and long-term therapy
must be anticipated. PEG-IFN offers a higher rate of sustained response in a
subgroup of patients, but is frequently complicated by side effects.
Pre-treatment predictors of response, including HBV genotype, alanine
aminotransferase and HBV DNA levels, aid in selecting patients for PEG-IFN
therapy. Furthermore, on-treatment markers such as quantitative hepatitis B
surface antigen may be applied to identify nonresponders early during the
PEG-IFN treatment course, thereby preventing unnecessary treatment.
Conclusions
Both nucleos(t)ide analogues and PEG-IFN can be prescribed as first-line
treatment options for CHB. However, PEG-IFN should only be considered for
patients with a high chance of response based on pre-treatment and on-treatment
factors.