Chronic Hepatitis B Treatment Options

Pros and Cons of Medications for HBV

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Treatment options for chronic hepatitis B have never been as good as they are today. Currently, there are at least six drugs available, compared to only 10 years ago when there were none, which means your doctor has options in finding the drug (or combination of drugs) that works best for you.

Despite many effective treatment options for Hepatitis B, there is still no cure for the disease. The goal of medical therapy is to suppress the virus and keep symptoms at bay while protecting the liver from the disease's damaging effects.

Also, it is important to keep in mind that not all hepatitis B patients require medication. And whether you begin drug therapy or not, you should be under the care of a physician who is either a specialist in liver diseases or very knowledgeable and experienced in treating hepatitis B. 

Hepatitis B Medication Pros and Cons

Most medications have benefits and side effects that should be weighed, and working with your physician can help you select the drug that has benefits expected to outweigh the risks. To help you understand these medications a little better, here are some of their strengths and weaknesses.

MedicationProsCons

Interferon (interferon alpha-2b or pegylated interferon)

  • Usually a good choice for young people without serious liver disease (well-compensated liver disease)
  • Good choice for genotype A infection
  • Treatment duration is relatively short (24 to 48 weeks) compared to other hepatitis B therapies.
  • Very serious side effects for some people
  • Not available for people with failing livers (decompensated liver disease)
  • Most expensive (regular or pegylated) compared to the other drugs
  • Pegylated interferon not approved for children 

Lamivudine

  • Least expensive compared to the other hepatitis B drugs
  • One of the older hepatitis B drugs, so a lot is known about its safety
  • Might be helpful in treating HIV co-infection in combination with tenofovir
  • Approved for both children and adults 
  • Often loses its effectiveness against the hepatitis B virus because of drug resistance
  • Because of resistance, it can be less effective than many of the newer hepatitis B drugs
  • Requires long-term treatment 

Adefovir dipivoxil

  • Can be used in patients with lamivudine-resistant hepatitis B virus 
  • Can be toxic to your kidneys at high doses
  • Requires long-term treatment  

Entecavir

  • Has an extremely low rate of resistance.
  • Might be helpful in patients with failing livers (decompensated liver disease)
  • A newer drug, so it has less research available about its safety--especially in certain conditions
  • Known to cause cancer in rodents when given in high doses, but no human data supports an increased risk in patients
  • Requires long-term treatment

Telbivudine

  • Might be a more powerful antiviral drug than lamivudine and adefovir
  • As likely as lamivudine to become resistant to hepatitis B virus
  • Requires long-term treatment
  • Not approved for children

Tenofovir

  • Excellent at treating regular and drug-resistant types of hepatitis B virus
  • Might be a good treatment choice when adefovir doesn't work well
  • Treats both HIV and the hepatitis B virus
  • It's a relatively new drug for treating hepatitis B, so more studies need to be completed
  • Not approved for children
  • Requires long-term treatment
  • Regular monitoring of kidney function is necessary

 

Source:

UpToDate. Basow, DS (Ed), UpToDate, Waltham, MA, 2010.

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