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Optimal therapy of chronic hepatitis B: how do I treat my HBeAg-negative patients?

Mauro Viganò1, Federica Invernizzi, Pietro Lampertico

  • 1Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.

Liver International : Official Journal of the International Association for the Study of the Liver
|December 23, 2014
PubMed

Insights

Pegylated interferon (PEG-IFN) offers potential HBsAg loss in chronic hepatitis B (CHB) patients, especially with careful selection. Nucleos(t)ide analogues (NA) provide viral suppression but have limitations for long-term CHB management.

Area of Science:

  • Hepatology
  • Virology
  • Internal Medicine

Background:

  • HBeAg-negative chronic hepatitis B (CHB) is a challenging phase requiring sustained viral suppression to prevent liver disease progression.
  • Current treatment options include short-term pegylated interferon alpha (PEG-IFN) and long-term nucleos(t)ide analogues (NA).

Purpose of the Study:

  • To compare the efficacy and limitations of PEG-IFN and NA therapies in managing HBeAg-negative CHB.
  • To explore strategies for optimizing PEG-IFN treatment outcomes and discuss the global preference for NA therapy.

Main Methods:

  • Review of current treatment strategies for HBeAg-negative CHB.
  • Analysis of outcomes associated with PEG-IFN and NA therapies, including viral suppression, biochemical normalization, and long-term sequelae.
  • Discussion of patient selection criteria and on-treatment monitoring for PEG-IFN therapy.

Main Results:

  • PEG-IFN can achieve sustained virologic response (SVR) in approximately 25% of patients, with HBsAg loss in 30-50%.
  • NA therapy offers excellent viral suppression and disease control but is associated with lifelong administration, costs, adherence issues, and limited HBsAg seroclearance.
  • Optimizing PEG-IFN response is possible through careful patient selection and monitoring of viral kinetics.

Conclusions:

  • PEG-IFN presents a viable option for achieving HBsAg loss in select CHB patients, potentially leading to treatment cessation.
  • NA therapy remains the dominant strategy for viral suppression but necessitates long-term management with associated challenges.
  • Further research into optimizing PEG-IFN and combination therapies is warranted for improved CHB outcomes.

Keywords:
HBeAg-negativechronic hepatitis Bentecavirnucleos(t)ide analoguespegylated interferonpegylated interferon alpha-2atenofovir

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