Alimentary Pharmacology & Therapeutics
Early View (Articles online in advance of print)
Summary
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.