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Why do I treat HBeAg‐negative chronic hepatitis B patients with nucleos(t)ide analogues?
Author(s) -
Papatheodoridis George V.
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12054
Subject(s) - medicine , entecavir , tenofovir , chronic hepatitis , adverse effect , gastroenterology , interferon , hbeag , first line , hepatitis b , pegylated interferon , hepatitis b virus , immunology , virus , lamivudine , hbsag , human immunodeficiency virus (hiv) , ribavirin
Products that are currently used in the treatment of chronic hepatitis B include interferon‐alpha ( IFN a: standard or pegylated) ( PEG ‐ IFN a) and nucleos(t)ide analogues ( NA s). NA s are used in most HB eAg‐negative chronic hepatitis B patients for several reasons. They can be prescribed to all chronic HBV patients, even those with contraindications to IFN a; and even IFN a candidates are usually treated with NA s because of their advantages. Administration of NA s is easier (one oral tablet per day compared with subcutaneous IFN a injections), tolerance is excellent and the safety profile is good, whereas IFN a may have adverse events and often worsens the patients’ quality of life. The current first‐line NA options, entecavir ( ETV ) and tenofovir ( TDV ), have minimal or no risk of long‐term resistance and a virological response is achieved in almost 100% of adherent HB eAg‐negative patients, thus modifying the long‐term outcome. The need for long‐term, perhaps indefinite, treatment is the main limitation of NA s and the finite duration (48 weeks), the main advantage of IFN a, especially in young patients of reproductive age. However, at most 25% of IFN a‐treated HB eAg‐negative patients achieve a sustained off‐treatment response and therefore >75% of them will eventually receive NA s, even if they start with IFN a. As there will always be concerns about safety and family planning issues with long‐term NA therapy, NA s should be used carefully, particularly in young chronic hepatitis B patients with mild liver disease. Novel therapeutic options are needed to increase the rates of HB sAg loss and sustained off‐treatment responses.