Current state-of-the-art pharmacotherapy for the management of hepatitis B infection

ABSTRACT

Introduction: Hepatitis B virus (HBV) infection remains a global challenge with several hundred million infected individuals. Disease activity can be controlled, and adverse outcomes prevented when treatment can be provided. Frequently life-long therapy is required instead of defined treatment periods such as with the case of Hepatitis C Virus (HCV) infection.

Areas covered: In this review, the authors provide an overview of current start of the art therapy for HBV and indicate where variation from the current guidelines could be considered. Certain patients may be eligible for treatment with suboptimal therapies when their baseline viral load is low. Identifying ideal candidates for interferon therapy will result in good sustained responses for some patients.

Expert opinion: The biggest challenge remains linking patients to care and therapy. Patients can nowadays be sufficiently treated before the disease advances to a more progressed phase. However, future therapies must be extremely safe and ideally limit the required treatment period. Given Hepatitis D Virus’s dependence on HBV and being a disease with an unmet clinical need, HDV may be the best target group for the development of a functional cure for hepatitis B.

KEYWORDS:

• Hepatitis B
• drug efficacy
• resistance
• antivirals
• nucleos(t)ide

Article highlights

• Hepatitis B therapy, especially if initiated early, can prevent adverse patient outcome.

• There are two principle treatment options: Interferon or Nucleos(t)ides.

• While interferons have side effects and are not indicated in patient with cirrhosis, interferon offers defined treatment duration with good success in ideal patients

• Nucleotis(t)ides are extremely safe and have been associated with reversal of even the most advanced liver disease stages

• Given the safety of current standard of care, future therapies need to be extremely safe too

• Given the high unmet need for hepatitis D virus infection, which is dependent on HBV, new treatment approaches aiming for functional cure shall be tested in this population with persistent unmet medical need.

This box summarizes key points contained in the article.

Declaration of interest

HL Tillmann declares that his wife is an employee of AbbVie who holds stock in Abbott, AbbVie, and Gilead Sciences. Dr Tillmann also declares that he has consulted for Trevena Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.