This commissioned review article was subject to full peer-review.
Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?
Article first published online: 29 DEC 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 5, pages 501–513, March 2011
How to Cite
Rijckborst, V., Sonneveld, M. J. and Janssen, H. L. A. (2011), Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?. Alimentary Pharmacology & Therapeutics, 33: 501–513. doi: 10.1111/j.1365-2036.2010.04555.x
- Issue published online: 24 JAN 2011
- Article first published online: 29 DEC 2010
- Publication data Submitted 13 August 2010 First decision 24 August 2010 Resubmitted 26 October 2010 Accepted 6 December 2010 EV Pub Online 29 December 2010
Aliment Pharmacol Ther 2011; 33: 501–513
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.