Background First-line treatment options for chronic hepatitis B (CHB) consist of nucleos(t)ide analogues with a high barrier to resistance (entecavir and tenofovir) or the immunomodulatory agent peginterferon (PEG-IFN). The optimal choice for individual patients remains controversial. Aim To review treatment options for CHB, with a focus on deciding between prolonged nucleos(t)ide analogue therapy or a finite course of PEG-IFN. Methods A comprehensive literature search was undertaken. Results Long-lasting, treatment-maintained suppression of hepatitis B virus (HBV) DNA without resistance is achievable in most patients by entecavir or tenofovir. A sustained off-treatment response is, however, unlikely and long-term therapy must be anticipated. PEG-IFN offers a higher rate of sustained response in a subgroup of patients, but is frequently complicated by side effects. Pre-treatment predictors of response, including HBV genotype, alanine aminotransferase and HBV DNA levels, aid in selecting patients for PEG-IFN therapy. Furthermore, on-treatment markers such as quantitative hepatitis B surface antigen may be applied to identify nonresponders early during the PEG-IFN treatment course, thereby preventing unnecessary treatment. Conclusions Both nucleos(t)ide analogues and PEG-IFN can be prescribed as first-line treatment options for CHB. However, PEG-IFN should only be considered for patients with a high chance of response based on pre-treatment and on-treatment factors.

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Keywords Hepatitis B virus, adefovir, agitation, alanine aminotransferase, alanine aminotransferase blood level, anorexia, antiviral activity, antiviral resistance, antiviral therapy, bleeding, bone marrow suppression, depression, drug approval, drug efficacy, drug indication, drug induced headache, drug potency, drug safety, drug tolerability, drug withdrawal, entecavir, eradication therapy, fatigue, flu like syndrome, genotype, hepatitis, hepatitis B, hepatitis B surface antigen, hepatitis B(e) antigen, human, immunomodulation, infection, injection site reaction, lamivudine, long term care, medical decision making, medical literature, myalgia, nephrotoxicity, neutropenia, nucleotide derivative, pathophysiology, patient selection, peginterferon, peginterferon alpha2a, peginterferon alpha2b, placebo, priority journal, prognosis, review, ribavirin, risk benefit analysis, seroconversion, side effect, telbivudine, tenofovir, tenofovir disoproxil, thrombocytopenia, thyroid disease, treatment duration, treatment response, unspecified side effect, virus DNA, virus load, virus mutation
Persistent URL dx.doi.org/10.1111/j.1365-2036.2010.04555.x, hdl.handle.net/1765/23004
Citation
Rijckborst, V, Sonneveld, M.J, & Janssen, H.L.A. (2011). Review article: Chronic hepatitis B - Anti-viral or immunomodulatory therapy?. Alimentary Pharmacology and Therapeutics, 33(5), 501–513. doi:10.1111/j.1365-2036.2010.04555.x