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. 

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.

Medication

Pros

Cons

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 support 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

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Article Sources
  • UpToDate. Basow, DS (Ed), UpToDate, Waltham, MA, 2010.