From the Guidelines
Chronic persistent hepatitis should be treated with antiviral medications, such as entecavir or tenofovir, for long-term management, especially in cases of hepatitis B, to reduce inflammation and prevent progression to more severe liver disease. The treatment approach depends on the underlying cause of the hepatitis, with viral hepatitis being the most common. For hepatitis B, the choice of antiviral medication is crucial, and factors such as the patient's HBeAg status, HBV DNA viral load, ALT levels, and stage of liver disease should be considered 1.
According to the most recent guidelines, patients with HBeAg-positive chronic hepatitis B and ALT greater than 2 times normal or moderate/severe hepatitis on biopsy should be considered for treatment with either lamivudine or IFN- 1. However, due to the high rate of drug resistance, lamivudine and telbivudine are not preferred except where only a short course of treatment is planned.
The goal of treatment is to achieve sustained viral suppression, reduce liver inflammation, and prevent progression to cirrhosis or liver cancer. Regular monitoring of liver function tests every 3-6 months is essential, along with periodic imaging and possibly follow-up biopsies to assess disease progression 1. Lifestyle modifications, such as avoiding alcohol, maintaining a healthy weight, and limiting medications that could further stress the liver, are also important for all patients.
Key considerations in choosing an antiviral agent include the safety and efficacy of the treatment, risks of drug resistance, costs of the treatment, and patient and provider preferences 1. The treatment strategy should be individualized based on the patient's specific needs and circumstances.
In summary, the treatment of chronic persistent hepatitis should focus on reducing inflammation, preventing progression to more severe liver disease, and maintaining normal liver function over time, with antiviral medications such as entecavir or tenofovir being the cornerstone of treatment for hepatitis B.
From the FDA Drug Label
Entecavir tablets are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease The treatment of chronic persistent hepatitis is supported by the FDA drug label, which indicates that entecavir is used for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease 2.
- The recommended dose of entecavir for chronic hepatitis B virus infection in nucleoside-inhibitor-treatment-naïve adults is 0.5 mg once daily.
- The recommended dose of entecavir for adults with a history of hepatitis B viremia while receiving lamivudine or known lamivudine or telbivudine resistance substitutions is 1 mg once daily 2.
From the Research
Definition and Characteristics of Chronic Persistent Hepatitis
- Chronic persistent hepatitis is a type of liver disease characterized by inflammation of the liver that lasts for more than 6 months 3.
- It is considered a benign and non-progressive disease that does not require therapy 3.
- The disease is often associated with positive HBV markers, and some patients may have persistent HBs antigenemia or HBe antigenemia 3.
Treatment Options for Chronic Hepatitis
- For chronic hepatitis C, treatment options include ledipasvir/sofosbuvir and daclatasvir/sofosbuvir, which have been shown to be effective and well-tolerated in patients with HCV genotype 4 infection 4, 5.
- For chronic hepatitis B, treatment options include tenofovir, entecavir, and pegylated interferon-alpha, which have been shown to be effective in suppressing viral replication and improving liver histology 6, 7.
- Combination therapies, such as pegylated interferon-alpha with entecavir or tenofovir, have also been shown to be effective in managing chronic hepatitis B 7.
Efficacy and Safety of Treatment Options
- Ledipasvir/sofosbuvir and daclatasvir/sofosbuvir have been shown to have high sustained virological response rates and are generally well-tolerated in patients with chronic hepatitis C 4, 5.
- Tenofovir and entecavir have been shown to be the most effective antiviral agents for chronic hepatitis B, with high rates of viral suppression and improvement in liver histology 6.
- Pegylated interferon-alpha monotherapy and combination therapies with entecavir or tenofovir have been shown to be effective in managing chronic hepatitis B, but may be associated with more adverse events 7.