Systematic review: combination therapies for treatment-naïve chronic hepatitis B
Version of Record online: 28 MAR 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 27, Issue 12, pages 1187–1209, June 2008
How to Cite
KUMAR, M. and SARIN, S. K. (2008), Systematic review: combination therapies for treatment-naïve chronic hepatitis B. Alimentary Pharmacology & Therapeutics, 27: 1187–1209. doi: 10.1111/j.1365-2036.2008.03695.x
- Issue online: 28 MAR 2008
- Version of Record online: 28 MAR 2008
- Publication data Submitted 11 January 2008 First decision 2 February 2008 Resubmitted 12 March 2008 Resubmitted 14 March 2008 Accepted 17 March 2008 Epub OnlineAccepted 28 March 2008
Background There is a renewed interest in use of combination therapies in treatment-naïve chronic hepatitis B (CHB) because of limitations of monotherapies.
Aim To discuss the current status of combination therapies in treatment-naïve CHB.
Methods PubMed search was done using ‘combination’, ‘sequential’ and ‘chronic hepatitis B’ as the search terms.
Results The two most popular combination therapies include ‘combination of nucleos(t)ide analogues’ and ‘combination of interferons and nucleos(t)ide analogues’. Combination therapies using two nucleos(t)ide analogues do not lead to higher long-term efficacy. However, addition of a nucleos(t)ide analogue with a good resistance profile to a nucleos(t)ide analogue with a lower genetic barrier to resistance decreases the risk of emergent resistance to the latter. Greater sustained virological, biochemical and seroconversion rates are observed with addition of lamivudine to conventional interferon, but pegylated-interferon monotherapy is equally effective as combination with lamivudine. Again, resistance to lamivudine is lower with its combination with interferons.
Conclusions The answer to the question whether hepatitis B can be treated better with combination or monotherapy remains largely unknown. Additional trials are warranted of combination therapies of peginterferon and potent nucleos(t)ide analogues or therapies with the combined use of nucleos(t)ide analogues or immunomodulators.