Time for an active antiviral therapy for hepatitis B: An update on the management of hepatitis B virus infection

Figures & data

Table 1 Characteristics of FDA approved drugs for treatment of hepatitis B

Name	Trade name	Strong points	Weak points	Approved
Interferon alpha -2b	Intron A	Finite duration of treatment Durable response post-treatment (for responders) No known resistance	Significant side effects 65%–70% fail to respond Needle injection High cost	1991
Lamivudine (LVD)	Epivir-HBV Zeffix (Asia)	Oral Safe with negligible side effects Least expensive Effective for ADV resistant HBV	Long-term treatment may be needed High incidence of resistance: 9.1%–20% at yr 1, 70% at yr 5 (esp. those with high baseline HBV DNA)	1998
Adefovir Dipivoxil (ADV)	Hepsera	Oral Effective against LVD-resistant HBV and ETV-resistant HBV Low resistance: 0 at yr 1, 2% at yr 2, 7% at yr 3, 15% at yr 4	Long-term treatment may be needed Long-term renal toxicity unknown 30% fail to respond Less potent than LVD or ETV	2002
Entecavir (ETV)	Baraclude	Oral Potent viral suppression: greater than LVD or ADV Effective for LVD-resistant HBV Resistance: 0.8% at yr 4 for treatment-naïve patients, 39.5% at yr 4 for LVD-resistant HBV	Long-term safety and efficacy unknown Risk of carcinogenicity in rodents (in very high doses) Cost >ADV >TLV >LVD	2005
Pegylated Interferon Alpha-2a	Pegasys	Finite duration of treatment Once weekly injection Durable response post-treatment (for responders) No known resistance	Needle injection Significant side effects 65%–70% fail to respond High cost	2005
Telbivudine	Tyzeka	Oral Potent viral suppression Resistance: 4% for HbeAg(+) CHB (cf. 9.1% for LVD), 2.7% for HbeAg(-) CHB (cf. 9.8% for LVD)	Long-term safety and efficacy beyond 1 year unknown Efficacy to LVD-resistant HBV unknown	2006

(Conjeevaram and Lok 2003; Marcellin et al 2004; Lau et al 2005; Chae and Hann 2006; Lai et al 2006; Colonno et al 2007)

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