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Unmet need in chronic hepatitis B management
Lilian Yan Liang1, Grace Lai-Hung Wong1
1Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China.
Clinical and Molecular Hepatology
|February 14, 2019
Summary
Chronic hepatitis B (CHB) management requires focusing on safety and achieving functional cure. Tenofovir alafenamide offers good viral suppression with favorable safety, while alanine aminotransferase normalization and hepatitis B surface antigen loss are key goals.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Chronic hepatitis B (CHB) management still has unmet needs despite advancements.
- Nucleos(t)ide analogues (NAs) are used long-term, making their safety profile critical.
- Emerging data highlights the prognostic significance of biochemical and virological markers.
Purpose of the Study:
- To review the current unmet needs in CHB management.
- To discuss the safety and efficacy of newer NAs like tenofovir alafenamide.
- To emphasize the importance of achieving functional cure as the ultimate treatment goal.
Main Methods:
- Literature review of recent developments in CHB management.
- Analysis of safety and efficacy data for nucleos(t)ide analogues.
- Discussion of prognostic markers such as ALT normalization and HBsAg seroclearance.
Main Results:
- Tenofovir alafenamide demonstrates potent viral suppression with favorable renal and bone safety.
- Alanine aminotransferase (ALT) normalization is associated with a 49% reduced risk of hepatic events.
- Hepatitis B surface antigen (HBsAg) seroclearance indicates potential NA discontinuation and reduced risk of hepatocellular carcinoma.
Conclusions:
- Functional cure, defined by HBsAg seroclearance, should be the primary treatment objective for CHB patients.
- Preemptive antiviral therapy can reduce mother-to-child transmission of hepatitis B virus.
- Antiviral resistance due to prior treatments with low-barrier NAs remains a challenge, impacting future NA selection.
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