Hepatitis B medical therapy
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Hepatitis B |
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Diagnosis |
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Treatment |
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Hepatitis B medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor In Chief: Cafer Zorkun, M.D., Ph.D. [2]
Treatment
In the first few months of infection, hepatitis B does not usually get treated. Up to 95% of adults clear the infection spontaneously without treatment. Therapy in this stage of infection does not seem to further improve the chances of spontaneous cure. Early antiviral treatment may only be required in fewer than 1% of patients, whose hepatitis B takes a very aggressive course ("fulminant hepatitis").
There are currently several treatments for chronic hepatitis B. While none of the available drugs usually clear the infection, they can stop the virus from replicating, and prevent liver damage such as cirrhosis and/or liver cancer. Treatments are available in the form of antiviral drugs such as lamivudine, adefovir, entecavir or telbivudine, and immune system modulators such as interferon alpha (Uniferon) or peg-interferon alpha (PEGASYS). There are several other antivirals under investigation. However, some individuals are much more likely to respond than others. It does not appear that combination therapy offers any advantages,[1] but may help in patients with resistant viruses, or in advanced liver disease where resistant viruses may lead to liver failure. In general, each treatment works by reducing the viral load by several orders of magnitude. In some patients, chronic hepatitis B takes a mild course and does not require immediate treatment. Treatment strategies should be individualized. Considerations include a person's risk for developing complications of persistent infection, a person's likelihood of adhering and responding to treatment, and potential risks such as side effects or development of viral resistance.
On March 29, 2005, the US Food and Drug Administration (FDA) approved Entecavir for the treatment of hepatitis B.[2]
On February 25, 2005, the EU Commission approved PEGASYS for the treatment of hepatitis B making it the first pegylated interferon to be approved for hepatitis B.[3]
On October 27, 2006, telbivudine gained FDA approval for treatment of chronic hepatitis B. It is marketed under the brand name Tyzeka in the US and Sebivo outside the US. It is already approved in Switzerland.[4]
Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk for cirrhosis and hepatocellular carcinoma (liver cancer).
Infants born to mothers known to carry hepatitis B can be treated with antibodies to the hepatitis B virus (hepatitis B immune globulin or HBIg). When given with the vaccine within twelve hours of birth, the risk of acquiring hepatitis B is reduced 95%. This treatment also allows a mother to safely breastfeed her child.
An individual exposed to the virus who has never been vaccinated may be treated with HBIg immediately following the exposure. For instance, a health care worker accidentally stuck by a needle used in a hepatitis B carrier would qualify. Treatment must be soon after exposure, however.
As a summary:
There are no medications available for recently acquired (acute) HBV infection. Hepatitis B vaccine is available for the prevention of HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.
- HBV infected persons should be evaluated by their doctor for liver disease.
- Adefovir dipivoxil, interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, entecavir, and telbivudine are six drugs used for the treatment of persons with chronic hepatitis B.
- These drugs should not be used by pregnant women.
- Drinking alcohol can make liver disease worse.
References
- ↑ Lau GKK; et al. (2005). "Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B". N Engl J Med. 352 (26): 2682–95. PMID 15987917.
- ↑ U.S. Food and Drug Administration. March 30, 2005. FDA Talk Paper: FDA Approves New Treatment for Chronic Hepatitis B. fda.gov. Retrieved on September 11, 2007.
- ↑ February 25, 2005. Pegasys approved in the European Union for the treatment of chronic hepatitis B: Only pegylated interferon approved for the treatment of chronic hepatitis B. roche.com. Retrieved on September 11, 2007.
- ↑ October 27, 2006. FDA Approves Telbivudine for Treatment of Chronic Hepatitis B. hivandhepatitis.com. Retrieved on September 11, 2007.