Hepatitis - Outlook

Highlights	Prognosis	Medications
Introduction	Symptoms	Resources
Risk Factors and Transmission	Diagnosis	References
Prevention	Treatment

Medications

Medications for Chronic Hepatitis B

Seven drugs are currently approved in the United States for treatment of chronic hepatitis B:

Peginterferon alfa-2a (Pegasys)
Interferon-alfa-2b (Intron A)
Lamivudine (Epivir-HBV)
Entecavir (Baraclude)
Telbivudine (Tyzeka)
Adefovir (Hepsera)
Tenofovir (Viread)

These drugs block the replication of hepatitis B in the body. They may also help prevent the development of progressive liver disease (cirrhosis and liver failure) and the development of liver cancer.

A doctor will decide which drug to prescribe based on a patient's age, disease severity, and other factors. A combination of drugs may also be prescribed. Peginterferon alfa-2a, entecavir, and tenofovir are the preferred drugs for first-line long-term treatment.

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It is not always clear which patients with chronic hepatitis B should receive drug therapy and when drug therapy should be started. Therapy is generally indicated for patients who have experienced a rapid deterioration in liver function, or patients with cirrhosis complications such as ascites and hemorrhage. [For more information on complications of cirrhosis, see In-Depth Report #75: Cirrhosis.]

Patients who are receiving immunosuppressive therapy for other medical conditions or who have had reactivation of chronic hepatitis B are also appropriate candidates.

Peginterferon alfa-2a. Peginterferon alfa-2a (Pegasys) was approved in 2005 for treatment of chronic hepatitis B. (Peginterferon is also called pegylated interferon.) This drug prevents the hepatitis B virus from replicating and also helps boost the immune system. It is given as a weekly injection. Peginterferon is sometimes prescribed in combination with lamivudine (Epivir-HBV).

Common side effects include flu-like symptoms, such as fever, chills, muscle aches, joint pains, and headaches. The drug can also cause depression, anxiety, irritability, and insomnia and should be used with caution in patients with a history of mental illness. Peginterferon alfa-2a can also increase the risk for infections, and worsening of hepatitis as marked by sudden severe increases in ALT levels. Patients who show signs of ALT flares should have frequent blood tests to monitor their liver function.