Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
All of the following medications described that are used to treat chronic
hepatitis B are antiviral medications. They reduce the ability of the virus to
reproduce in the body and give the liver a chance to heal itself. These drugs
are not a cure for hepatitis B, but they do reduce the damage caused by the
virus. Although these medications are similar in some ways, they differ in other
important ways. Talk to your health care practitioner about the best medication for
Pegylated interferon alfa-2b (Pegasys®)
Pegylated interferon is used alone
or in combination with other medications.
Pegylated interferon slows the replication of the virus and boosts the
body's immune system to fight the infection.
It works best in people who have relatively low levels of HBV DNA (low
Pegylated interferon usually is not given to people whose liver damage has
progressed to cirrhosis, because it can make the liver damage worse.
Treatment is often given for 48 weeks, which is shorter than for other
medications, but pegylated interferon requires regular shots (injections) while
other medications are taken orally.
Pegylated interferon has unpleasant side effects in many people. The side
effects are similar to having the
flu. For many people, side effects are so
severe that they cannot continue taking the medication.
Liver function tests and HBV DNA tests are used to check how well the
treatment is working.
Interferon appears to stop the liver damage in up to 40% of people although
relapse is possible.
Nucleoside/nucleotide analogues (NAs)
Nucleoside/nucleotide analogues (NAs) are compounds that mimic normal
building blocks for DNA. When the virus tries to use the analogues, it is unable
to make new viral particles. Examples of these agents include adefovir
(Hepsera®), entecavir (Baraclude®), lamivudine (Epivir-HBV®, Heptovir®,
Heptodin®), Telbivudine (Tyzeka®) and tenofovir (Viread®).
NAs reduce the amount of virus in the body. Between 20% and 90% of patients
may have levels reduced so far that they become undetectable. Obviously, this is
a broad range. The higher success rates are achieved in patients who do not have
"hepatitis B e antigen" (HBeAg). HBeAg is detected by a blood test and indicates
that the virus is actively multiplying.
Side effects are less common than with pegylated interferon. NAs have been
associated with changes in body fat distribution, reduced blood cell counts, and
increased levels of lactic acid in the blood. Rarely, NAs are associated with a
severe flare of hepatitis that can be serious or fatal.
HBV may become resistant to NAs over time.
NAs do not cure the infection. Relapse is possible even in patients who
have had a good response to treatment.