REVIEW ARTICLE: CHRONIC HEPATITIS B - ANTIVIRAL OR IMMUNOMODULATORY THERAPY?

Vincent Rijckborst (1) , Milan J Sonneveld (1) , Harry L Janssen (2)

1 Gastroenterology & Hepatology
2 Gastroenterology & Hepatology

Background: First-line treatment options for chronic hepatitis B (CHB) consist of nucleos(t)ide analogues (NA) 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 NA 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. Pretreatment 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 NA 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 pretreatment and on-treatment factors.

Mots clés: Medicine

Vincent Rijckborst, Milan J Sonneveld, Harry L Janssen. REVIEW ARTICLE: CHRONIC HEPATITIS B - ANTIVIRAL OR IMMUNOMODULATORY THERAPY?. Alimentary Pharmacology and Therapeutics, 2010, 33 (5), pp.501. ⟨10.1111/j.1365-2036.2010.04555.x⟩. ⟨hal-00604414⟩