From the Guidelines
Hepatitis B treatment should be initiated with a potent nucleos(t)ide analogue, such as entecavir or tenofovir, in patients with chronic HBV infection and HBV DNA ≥ 2,000 IU/ml, elevated ALT, and/or at least moderate histological lesions, as this approach has been shown to improve survival and quality of life by preventing disease progression and HCC development 1. The goal of therapy is to induce long-term suppression of HBV replication, with HBsAg loss being an optimal endpoint.
- Key considerations for treatment include:
- Viral load: HBV DNA ≥ 2,000 IU/ml
- Liver enzyme levels: elevated ALT
- Degree of liver damage: at least moderate histological lesions
- Patient population: all cirrhotic patients with detectable HBV DNA should be treated, as well as pregnant women with high viremia and patients requiring immunosuppression or chemotherapy
- First-line treatment options include:
- Entecavir (0.5-1mg daily)
- Tenofovir (300mg daily)
- Pegylated interferon alfa (180mcg weekly injections for 48 weeks) may be considered in mild to moderate chronic hepatitis B patients
- Regular monitoring through blood tests every 3-6 months is essential to assess treatment effectiveness and detect any liver complications, as HCC remains a major concern for treated chronic hepatitis B patients 1.
- Patients should avoid alcohol, maintain a healthy diet, and get vaccinated against hepatitis A to prevent additional liver stress.
- Early treatment significantly reduces the risk of developing cirrhosis, liver failure, or liver cancer.
From the FDA Drug Label
Entecavir tablets are a prescription medicine used to treat chronic hepatitis B virus (HBV) in adults who have active liver disease. Entecavir tablets will not cure HBV. Entecavir tablets may lower the amount of HBV in the body. Entecavir tablets may lower the ability of HBV to multiply and infect new liver cells. Entecavir tablets may improve the condition of your liver
Treatment of Hepatitis B involves the use of prescription medicines like entecavir tablets. The treatment:
- May lower the amount of HBV in the body
- May lower the ability of HBV to multiply and infect new liver cells
- May improve the condition of the liver However, entecavir tablets will not cure HBV 2.
From the Research
Treatment Options for Hepatitis B
- The goal of antiviral therapy in patients with chronic hepatitis B is to prevent cirrhosis and hepatocellular carcinoma through persistent suppression of HBV replication 3.
- Seven drugs are available for the treatment of chronic hepatitis B: IFN-alpha, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 3.
- The choice of drug should consider the clinical features of patients, antiviral efficacy, risk of developing resistance, long-term safety profile, method of administration, and cost of therapy 3.
Ideal Candidates for Treatment
- Ideal candidates for treatment are hepatitis B e antigen-positive patients with a prolonged phase of immune clearance and hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase, and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 3.
- Patients with compensated or decompensated cirrhosis should be treated, even if alanine aminotransferase levels are normal and/or serum HBV DNA levels are low, to prevent disease flare and improve liver function 3.
Treatment Guidelines
- Antiviral treatment should be initiated in patients with chronic hepatitis B who have a high risk of liver-related morbidity and are likely to respond to treatment 4.
- Treatment should be initiated with one of the recommended first-line therapies (pegylated interferon-α, entecavir, or tenofovir), and treatment efficacy should be monitored regularly for serum HBV DNA, alanine aminotransferase, and serologic responses 4.
- Patients who are not immediately considered for treatment should be monitored and started on antiviral therapy in case of disease progression 4.
Oral Antivirals
- Four oral antiviral agents have been approved for the treatment of chronic hepatitis B: lamivudine, adefovir, entecavir, and telbivudine 5.
- The durability of response, dose regimen, predictors of response, safety, and problems with resistance of these agents should be considered when selecting a treatment option 5.
First-Line Treatment
- Treatment options for chronic hepatitis B include pegylated interferon (Peg-IFN) in minimal-mild liver fibrosis and nucleot(s)ide analogues (NUC) in more advanced disease 6.
- The choice between Peg-IFN and NUC as first-line therapy is influenced by factors such as age and the execution of liver biopsy 6.