final program.qxd - Parallels Plesk Panel

OP 9.1
New Developments in the Treatment of Chronic Hepatitis B
Stephanos J. Hadziyannis M.D.
Professor of Medicine
Athens, Greece
Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial
issues. There are two major types of chronic hepatitis B, one with positive and the other
with negative HBeAg, to which largely differing initiation criteria and end-points of therapy
should be applied; their natural course is highly variable and frequently unpredictable;
therapeutic options with currently approved and developing drugs differ significantly
depending on the severity of liver necro-inflammation, the stage of fibrosis and on the
functional capacity of the affected liver. In addition to these variables there are many other,
yet unresolved, issues, including cost and long-term safety and resistance. Experts may
have differing views regarding the best treatment approach and practicing clinicians have
to find the way out in making, evidence-based treatment decisions appropriate for
individual patients. In this presentation new developments in the therapy of chronic
hepatitis B with emphasis on treatment strategies , first line/first choice drugs and
treatment paradigms will be critically discussed.
All hitherto approved drugs are considered as first line therapies both for HBeAg-positive
and HBeAg-negative CHB. In general, finite courses of therapy in both types of CHB with
interferon-alfa appear to be more efficacious compared to finite courses of n.analogues
courses at least in terms of sustained virological response (SVR) rates. Notably,
in HBeAg-negative CHB, SVRs are rarely achievable (30% of
patients with compensated chronic hepatitis B. It is also becoming generally acceptable
that if a patient does not respond to or cannot tolerate or is reluctant to IFN-alfa therapy,
then n.analogue therapy should be applied. In the case of HBeAg-negative patients
n.analogue therapy should be very long lasting aiming at effective on-therapy HBV
suppression, maintained without development of drug resistance. However the end points
and optimal duration of such long therapies have not been established as yet.
The advantages and disadvantages, the weak and strong points of the approved and
coming n. analogues will be further discussed. For the time being, the best long-term
resistance profile has been documented in adefovir dipivoxil treatment. However, its cost
is high and it is becoming clear that going monotherapy with any n. analogue cannot be
expected to be free of long-term HBV resistance. The current evidence on the efficacy of
combination therapies in treating lamivudine- or other nucleoside analogue-resistant HBV
patients will also be reviewed.
“ Focusing FIRST on PEOPLE “ 70 w w w . i s h e i d . c o m