What are the treatments for hepatitis B and hepatitis C?

From the Guidelines

The most effective treatment for hepatitis B and hepatitis C involves antiviral medications, with entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide being preferred for hepatitis B, and direct-acting antivirals (DAAs) such as Epclusa, Mavyret, and Harvoni offering a cure for hepatitis C in most cases. For chronic hepatitis B, antiviral medications like entecavir (0.5-1mg daily), tenofovir disoproxil fumarate (300mg daily), or tenofovir alafenamide (25mg daily) are typically prescribed for long-term suppression of the virus, as recommended by the study published in the Journal of Clinical Oncology 1. These medications rarely cure the infection but effectively control viral replication and prevent liver damage.

For hepatitis C, direct-acting antivirals (DAAs) offer a cure in most cases with 8-12 weeks of treatment, with common regimens including Epclusa (sofosbuvir/velpatasvir) taken as one pill daily for 12 weeks, Mavyret (glecaprevir/pibrentasvir) taken as three pills once daily for 8-12 weeks depending on liver condition, or Harvoni (ledipasvir/sofosbuvir) taken as one pill daily for 8-12 weeks, as outlined in the study published in the Journal of Hepatology 1. Treatment choice depends on the hepatitis C genotype, prior treatment history, and presence of cirrhosis.

Some key points to consider in the treatment of hepatitis B and C include:

• Avoiding alcohol and maintaining a healthy diet to prevent liver damage
• Getting vaccinated against hepatitis A if not immune
• Undergoing regular liver monitoring to track disease progression and response to treatment
• Considering the patient's HIV status prior to starting antiviral therapy, as some medications have anti-HIV properties 1
• Recognizing that acute hepatitis B often resolves without treatment, while acute hepatitis C may be treated early to prevent chronic infection

Overall, the goal of treatment for hepatitis B and C is to suppress viral replication, prevent liver damage, and reduce the risk of complications such as cirrhosis and hepatocellular carcinoma, as discussed in the study published in the Journal of Hepatology 1. By prioritizing the most effective antiviral medications and considering individual patient factors, healthcare providers can help improve outcomes and quality of life for patients with these conditions.

From the FDA Drug Label

Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with ledipasvir and sofosbuvir Ledipasvir and sofosbuvir is indicated for the treatment of adults and pediatric patients 3 years of age and older with chronic hepatitis C virus (HCV) Entecavir 1 mg once daily versus adefovir dipivoxil 10 mg once daily in 191 adult subjects with HBeAg-positive or -negative chronic HBV infection Entecavir has not been evaluated in HIV/HBV co-infected patients who were not simultaneously receiving effective HIV treatment

The treatments for hepatitis B and hepatitis C are as follows:

• Hepatitis C: Ledipasvir and sofosbuvir is indicated for the treatment of adults and pediatric patients 3 years of age and older with chronic hepatitis C virus (HCV)
• Hepatitis B: Entecavir 1 mg once daily is used for the treatment of chronic HBV infection Key points to consider:
• Testing for HBV infection is necessary before initiating treatment with ledipasvir and sofosbuvir for HCV
• Entecavir has been evaluated in patients with HBV infection, including those with decompensated liver disease and those co-infected with HIV 2 3

From the Research

Treatment 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 4.
• Seven drugs are available for the treatment of chronic hepatitis B: IFN-alpha, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 4, 5.
• 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 4.
• Pegylated interferon alfa-2a, entecavir, and tenofovir are recommended as first-line treatment options for chronic hepatitis B 6.

Treatment for Hepatitis C

• Direct-acting antiviral agents (DAAs) have been approved for treating chronic hepatitis C (CHC) genotype-2 (GT-2) patients, including sofosbuvir (SOF) plus different NS5A inhibitors, and non-SOF-based DAAs, such as glecaprevir/pibrentasvir (GLE/PIB) 7.
• The overall sustained virological response (SVR) rate for CHC GT-2 patients treated with DAAs is 97.9% 7.
• SOF in combination with DCV, LDV, or VEL, as well as GLE/PIB, achieved similar high efficacies, regardless of cirrhosis, treatment experience, or chronic kidney disease status 7.

Comparison of Treatment Options

• For chronic hepatitis B, the choice of treatment should take into consideration the clinical features of patients, the antiviral efficacy of each drug, the risk of developing resistance, the long-term safety profile, the method of administration, and the cost of therapy 4, 5.
• For chronic hepatitis C, the use of DAA therapy to eradicate HCV should not be delayed in patients with cirrhosis, treatment experience, or chronic kidney disease status 7.
• New therapeutic strategies in clinical development aim at a functional cure for chronic hepatitis B, with the goal of eliminating HBsAg from the serum 8.