A treatment algorithm for the management of this disease was published previously by a panel of USA hepatologists.
The treatment algorithm has been revised on the basis of new developments in the understanding of the disorder, the availability of more sensitive molecular diagnostic tests, and the licensure of new therapies.
In addition, a better understanding of the advantages and disadvantages of new treatments has led to the development of strategies for reducing the rate of resistance associated with oral agents and optimizing treatment outcomes.
Professor Emmet Keeffe and colleagues from California, USA based this updated algorithm primarily on available evidence by using a systematic review of the literature.
Where data were lacking, the panel relied on clinical experience and consensus expert opinion.
The primary aim of antiviral therapy is durable suppression of serum Hepatitis B virus DNA to low or undetectable levels.
Assays can now detect serum Hepatitis B DNA at levels as low as 10 IU/mL.
|Interferon alfa-2b and lamivudine are approved as initial therapy for chronic Hep B|
|Clinical Gastroenterology & Hepatology|
This should be used to establish a baseline level, monitor response to antiviral therapy, and survey for the development of drug resistance.
The team found that interferon alfa-2b, lamivudine, adefovir, entecavir, peginterferon alfa-2a, telbivudine, and tenofovir are approved as initial therapy for chronic Hepatitis B and have certain advantages and disadvantages.
Professor Keeffe’s team concludes, “Although all of these agents can be used in selected patients, the preferred first-line treatment choices are entecavir, peginterferon alfa-2a, and tenofovir.”
“We considered issues for therapy, including efficacy, safety, rate of resistance, method of administration, and cost.”