Interferon and nucleoside analog combination therapy for hepatitis B

Interferon therapy has several advantages over nucleoside or nucleotide analog therapy: finite duration, durable treatment response, and no viral resistance. However, it is only effective in about 30% of patients. To improve its efficacy, the combination of interferon and nucleoside/nucleotide analogs may facilitate additive or synergistic effects. This is because interferon and nucleoside/nucleotide analogs have different mechanisms of action. Recent studies demonstrate that concomitant use of lamivudine and peginterferon does not improve biochemical and virological responses compared with peginterferon monotherapy. By contrast, sequential or staggered administration of lamivudine and interferon appears to have some benefits over monotherapies. There is a paucity of data on interferon combined with drugs other than lamivudine, such as adefovir and entecavir. Although combination therapies have the potential to improve efficacy against hepatitis-B virus, it is unclear how interferon should be combined with other drugs or which patients should be treated with combination therapies.