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Hepatitis B Treatment (cont.)

Treatment Decisions for Hepatitis B

Treatment is usually considered when the risk of complications is high. This would include individuals who have a persistently high viral load, those who have HBeAg in their blood, and those who have signs or symptoms of liver dysfunction. There is no 'rule' for when to start treatment, and the decision is usually made jointly between the physician and the patient. If a decision is made not to treat, patients are monitored regularly to ensure that their disease is not progressing quickly and to evaluate their candidacy for new agents that might be available on the market.

The decision of whether to use nucleotide/nucleoside analogues or pegylated interferon is also individualized. Patients at high risk for neuropsychiatric side effects of pegylated interferon may choose to start with a nucleotide/nucleoside analogue. Nucleotide/nucleoside analogues, especially lamivudine, are more likely to induce resistance in the virus, rendering the drug ineffective after a few months or years.

Investigational Medications for Hepatitis B

New nucleoside/nucleotide analogues are being developed to try to improve outcomes or limit side effects or resistance in hepatitis B. One example is emtricitabine (Emtriva), which is already approved for use in HIV. Other examples include clevudine (L-FMAU), pradefovir, alamifovir, valtorcitabine, and medications that are currently identified only with drug numbers such as ANA380 (LB80380), ANA-975, and others.

Although currently available vaccines against hepatitis B are not effective in patients who already have chronic hepatitis B, new vaccines are being developed that may one day help stimulate the body's immune system in combination with medical treatment.

Combination therapies using two nucleoside/nucleotide analogues or analogues plus pegylated interferon have not shown superiority to single-agent therapy.

Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease

REFERENCE:

"Overview of the management of hepatitis B and case examples"
UpToDate.com


Medically Reviewed by a Doctor on 7/7/2016
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