Article information
Abstract
Objective
To define the role of those drugs available for hepatitis B treatment and analyze current treatment guides prepared by the leading scientific societies in the field.
MethodsBibliographic searches were carried out in the databases PubMed and EMBASE, using the search word “hepatitis B,” limited by “drug therapy” plus “clinical trial,” “meta-analysis,” or “guidelines,” within the period 1991–2007.
ResultsSix drugs are currently available: interferon alfa (conventional or pegylated), lamivudine, adefovir, entecavir, and telbivudine. In normal practice, pegylated interferon has almost completely displaced the conventional variety. HBeAg+ patients with high ALT levels, low HBV DNA counts and genotypes A and B show the best response to interferon.
Lamivudine achieves faster and more potent viral suppression than adefovir; its principal drawback is the resistance that some patients develop. Its role will probably decrease as entecavir and telbivudine become more widespread, as they are associated with less resistance. Adefovir is useful in decompensated patients and/or those resistant to lamivudine.
Because of the response rates it obtains, entecavir could be the drug of choice for HBeAG+ patients, particularly those with higher viral loads. For HBeAg– cases, any drug can be used as a first-choice drug. The main difference between the treatment guides lies in the way they define the illness and the serum markers that indicate active replication: viral loads and HBeAG positivity.
ConclusionsAll of the drugs are capable of accomplishing shortterm biochemical, viral and histological objectives. There is no unanimous opinion on which patients should be treated with which drugs, during what length of time, and what objectives are to be reached.
Key words:
Hepatitis B
Interferon alfa 2b
Pegylated interferon alfa 2a
Lamivudine
Adefovir
Entecavir
Telbivudine
Clinical practice guides
Objetivo
Definir el papel de los fármacos disponibles para el tratamiento de la hepatitis B y analizar las actuales guías de tratamiento de las principales sociedades científicas relacionadas.
MétodoSe realizaron sendas búsquedas bibliográficas en las bases de datos PubMed y EMBASE con el término hepatitis B, limitado a drug therapy y clinical trial, metaanálisis o guidelines, en el período 1991–2007.
ResultadosActualmente son 6 los fármacos disponibles: interferón alfa (convencional o pegilado), lamivudina, adefovir, entecavir y telbivudina. En la práctica habitual, el interferón pegilado ha desplazado casi completamente al convencional. Los pacientes con antígeno E del virus de la hepatitis B (VHB) positivo (HBeAg+) con concentraciones elevadas de alaninotransferasa (ALT), cifras bajas de ADN-VHB y genotipos A y B son los que mejor responden al interferón. Lamivudina consigue una supresión viral más rápida y potente que adefovir; su principal problema es la resistencia que genera. Probablemente, su papel disminuirá con la incorporación de entecavir y telbivudina, asociados con menores resistencias. Adefovir es útil en los pacientes descompensados y/o resistentes a lamivudina. Debido a las tasas de respuestas obtenidas, entecavir podría ser el fármaco de elección en pacientes HBeAg+, fundamentalmente en los que tienen cargas virales más altas. En HBeAg–, cualquier fármaco podría ser utilizado como primera opción. Las guías difieren, principalmente, en la definición de la enfermedad y los marcadores séricos que indican replicación activa: cargas virales y positividad del HBeAg.
ConclusionesTodos los fármacos son capaces de alcanzar los objetivos bioquímicos, virales e histológicos a corto plazo. No hay unanimidad acerca de qué pacientes tratar, con qué fármacos, durante cuánto tiempo y cuáles son los objetivos perseguidos.
Palabras clave:
Hepatitis B
Interferón alfa 2b
Interferón pegilado alfa 2a
Lamivudina
Adefovir
Entecavir
Telbivudina
Guías de práctica clínica
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