Drugs treatment of hepatitis B

Abstract Objective To define the role of those drugs available for hepatitis B treatment and analyze current treatment guides prepared by the leading scientific societies in the field. Methods Bibliographic searches were carried out in the databases PubMed and EMBASE, using the search word “hepatitis B,” limited by “drug therapy” plus “clinical trial,” “meta-analysis,” or “guidelines,” within the period 1991–2007. Results Six drugs are currently available: interferon alfa (conventional or pegylated), lamivudine, adefovir, entecavir, and telbivudine. In normal practice, pegylated interferon has almost completely displaced the conventional variety. HBeAg+ patients with high ALT levels, low HBV DNA counts and genotypes A and B show the best response to interferon. Lamivudine achieves faster and more potent viral suppression than adefovir; its principal drawback is the resistance that some patients develop. Its role will probably decrease as entecavir and telbivudine become more widespread, as they are associated with less resistance. Adefovir is useful in decompensated patients and/or those resistant to lamivudine. Because of the response rates it obtains, entecavir could be the drug of choice for HBeAG+ patients, particularly those with higher viral loads. For HBeAg– cases, any drug can be used as a first-choice drug. The main difference between the treatment guides lies in the way they define the illness and the serum markers that indicate active replication: viral loads and HBeAG positivity. Conclusions All of the drugs are capable of accomplishing shortterm biochemical, viral and histological objectives. There is no unanimous opinion on which patients should be treated with which drugs, during what length of time, and what objectives are to be reached.