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      The treatment of chronic hepatitis B: Focus on adefovir-like antivirals

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          Abstract

          Several options for the treatment of hepatitis B have been licensed in the last years: interferon, pegylated interferon, lamivudine, adefovir, entecavir, and telbivudine. In addition tenofovir has been licensed in the EU and is expected to be licensed in the USA in 2008. The antivirals can be divided into “lamivudine-like” and “adefovir-like”, which clinically differ in their capacity to induce “YMDD” mutants, which are the hallmark of lamivudine resistance. The differing resistance profile makes them good combination partners, even in the absence of synergy in antiviral potency.

          Most cited references60

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          Chronic hepatitis B.

          Anna Lok, Brian McMahon (2007)
          Article 0 comments Cited 356 times – based on 0 reviews     Review now
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            Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B.

            George K. K. Lau, Teerha Piratvisuth, Kang Luo … (2005)
            Current treatments for chronic hepatitis B are suboptimal. In the search for improved therapies, we compared the efficacy and safety of pegylated interferon alfa plus lamivudine, pegylated interferon alfa without lamivudine, and lamivudine alone for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. A total of 814 patients with HBeAg-positive chronic hepatitis B received either peginterferon alfa-2a (180 microg once weekly) plus oral placebo, peginterferon alfa-2a plus lamivudine (100 mg daily), or lamivudine alone. The majority of patients in the study were Asian (87 percent). Most patients were infected with hepatitis B virus (HBV) genotype B or C. Patients were treated for 48 weeks and followed for an additional 24 weeks. After 24 weeks of follow-up, significantly more patients who received peginterferon alfa-2a monotherapy or peginterferon alfa-2a plus lamivudine than those who received lamivudine monotherapy had HBeAg seroconversion (32 percent vs. 19 percent [P<0.001] and 27 percent vs. 19 percent [P=0.02], respectively) or HBV DNA levels below 100,000 copies per milliliter (32 percent vs. 22 percent [P=0.01] and 34 percent vs. 22 percent [P=0.003], respectively). Sixteen patients receiving peginterferon alfa-2a (alone or in combination) had hepatitis B surface antigen (HBsAg) seroconversion, as compared with 0 in the group receiving lamivudine alone (P=0.001). The most common adverse events were those known to occur with therapies based on interferon alfa. Serious adverse events occurred in 4 percent, 6 percent, and 2 percent of patients receiving peginterferon alfa-2a monotherapy, combination therapy, and lamivudine monotherapy, respectively. Two patients receiving lamivudine monotherapy had irreversible liver failure after the cessation of treatment--one underwent liver transplantation, and the other died. In patients with HBeAg-positive chronic hepatitis B, peginterferon alfa-2a offers superior efficacy over lamivudine, on the basis of HBeAg seroconversion, HBV DNA suppression, and HBsAg seroconversion.
            Article 0 comments Cited 274 times – based on 0 reviews     Review now
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              Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level.

              Hwai-I Yang, San-Lin You, Uchenna Iloeje … (2006)
              Serum hepatitis B virus (HBV) DNA level is a marker of viral replication and efficacy of antiviral treatment in individuals with chronic hepatitis B. To evaluate the relationship between serum HBV DNA level and risk of hepatocellular carcinoma. Prospective cohort study of 3653 participants (aged 30-65 years), who were seropositive for the hepatitis B surface antigen and seronegative for antibodies against the hepatitis C virus, recruited to a community-based cancer screening program in Taiwan between 1991 and 1992. Incidence of hepatocellular carcinoma during follow-up examination and by data linkage with the national cancer registry and the death certification systems. There were 164 incident cases of hepatocellular carcinoma and 346 deaths during a mean follow-up of 11.4 years and 41,779 person-years of follow-up. The incidence of hepatocellular carcinoma increased with serum HBV DNA level at study entry in a dose-response relationship ranging from 108 per 100,000 person-years for an HBV DNA level of less than 300 copies/mL to 1152 per 100,000 person-years for an HBV DNA level of 1 million copies/mL or greater. The corresponding cumulative incidence rates of hepatocellular carcinoma were 1.3% and 14.9%, respectively. The biological gradient of hepatocellular carcinoma by serum HBV DNA levels remained significant (P or =10,000 copies/mL) is a strong risk predictor of hepatocellular carcinoma independent of HBeAg, serum alanine aminotransferase level, and liver cirrhosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (publisher-id): Therapeutics and Clinical Risk Management
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date (Print): August 2008
                Publication date (Electronic): August 2008
                Volume: 4
                Issue: 4
                Pages: 797-802
                Affiliations
                Medizinische Klinik und Poliklinik II, Universität Leipzig, Germany
                Author notes
                Correspondence: Hans L Tillmann, Duke Clinical Research Institute, 2400, Pratt St, Durham, NC 27705, USA, Tel +1 919 668 4620, Fax +1 919 668 7164, Email Hans.Tillmann@ 123456duke.edu
                Article
                Publisher ID: tcrm-4-797
                PMC ID: 2621388
                PubMed ID: 19209262
                SO-VID: 2028e9bd-3499-4153-b8de-d95394c7cbeb
                Copyright © © 2008 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: pradefovir,hepatitis b,adefovir,almefovir,antiviral therapy,tenofovir
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: pradefovir, hepatitis b, adefovir, almefovir, antiviral therapy, tenofovir

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