Nucleos(t)ide analogues

“Two classes of drugs are approved for the treatment of CHB: peginterferon and nucleos(t)ide analogues (NAs).” (opens the source at this quote in a new tab)CopyFlag

“There are three NAs that are preferred for treatment of CHB: entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF). All 3 drugs provide high efficacy in achieving HBV DNA suppression, have low rates of antiviral resistance, and are well tolerated and broadly applicable (including for persons with decompensated cirrhosis and immunocompromised states).” (opens the source at this quote in a new tab)CopyFlag

“Selecting among these drugs is based upon availability/cost, age, presence of renal or bone disease (avoid TDF), pregnancy (avoid ETV), HIV coinfection (avoid ETV unless HIV RNA suppressed on antiretroviral regimen), and prior treatment history (avoid ETV if prior lamivudine exposure).” (opens the source at this quote in a new tab)CopyFlag

“TAF is not recommended if creatinine clearance is less than 15mL/min and not yet on dialysis.” (opens the source at this quote in a new tab)CopyFlag

“The goals of antiviral treatment are prevention of progression to cirrhosis, development of hepatocellular carcinoma (HCC) and liver-related death.” (opens the source at this quote in a new tab)CopyFlag

“If cirrhosis is present, persons should initiate antiviral therapy regardless of HBV DNA or ALT level.” (opens the source at this quote in a new tab)CopyFlag

“For HBeAg positive persons without cirrhosis, antiviral treatment is indicated for an ALT level ≥2 X ULN and HBV DNA ≥20,000 IU/mL.” (opens the source at this quote in a new tab)CopyFlag

“For HBeAg negative persons without cirrhosis, treatment is indicated for an ALT level ≥2 X ULN and HBV DNA ≥2,000 IU/mL.” (opens the source at this quote in a new tab)CopyFlag

“Treatment of these individuals has been shown to reduce the incidence of progression to cirrhosis, development of HCC, need for liver transplantation and HBV-related liver mortality.” (opens the source at this quote in a new tab)CopyFlag

“The AASLD recommends antiviral therapy for adults with immune-active CHB (HBeAg negative or HBeAg positive) to decrease the risk of liver-related complications” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“The AASLD recommends peg-IFN, entecavir, or tenofovir (TDF) as preferred initial therapy for adults with immune-active CHB” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“TAF is also a preferred initial therapy for adults with immune-active CHB.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“Consider TAF or entecavir in patients with or at risk for renal dysfunction or bone disease.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“However, in recommending peg-IFN, tenofovir, and entecavir as preferred therapies, the most important factor considered was the lack resistance with long-term use.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“ETV, TDF, or TAF should be used as first-line NA therapy. When selecting between ETV, TDF and TAF, comorbidities (especially renal insufficiency and reduction in bone density) and concomitant circumstances (e.g. women of childbearing age, pregnancy, age) as well as previous therapies should be taken into account (LoE 1, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)CopyFlag

“The virological response (HBV DNA <LOD) in naïve patients with these NAs increases over time and is ≥85% after 5 years of treatment, with HBeAg-negative patients showing a higher response of ≥90% (Table 10).” (opens the source at this quote in a new tab)CopyFlag

“Patients with HBeAg-positive or HBeAg-negative chronic hepatitis B, HBV DNA level ≥2,000 IU/ml and elevated ALT (>ULN) and/or significant fibrosis should receive antiviral therapy (LoE 1, strong recommendation, strong consensus).” (opens the source at this quote in a new tab)CopyFlag

“For all adults, adolescents and children (two years or older) for whom antiviral therapy is indicated, the nucleos(t)ide analogues that have a high genetic barrier to drug resistance – tenofovir disoproxil fumarate (TDF) or entecavir (ETV) are recommended as preferred regimens.” (opens the source at this quote in a new tab)CopyFlag

“Nucleos(t)ide analogues with a low genetic barrier to resistance (lamivudine, adefovir or telbivudine) can lead to drug resistance and are not recommended.” (opens the source at this quote in a new tab)CopyFlag

“We analyzed 34 published studies (with 42,588 patients, 303,754 person-years of follow-up, and 3194 HBsAg seroclearance events), including additional and updated aggregated data from 19 studies. The pooled annual rate of HBsAg seroclearance was 1.02% (95% CI, 0.79-1.27). Cumulative incidence rates were 4.03% at 5 years (95% CI, 2.49-5.93), 8.16% at 10 years (95% CI, 5.24-11.72), and 17.99% at 15 years (95% CI, 6.18-23.24).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“HBsAg seroclearance was not associated with HBV genotype or treatment history.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“Patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“By year 8, 2%–3% of patients had achieved HBsAg loss with or without seroconversion (Table 2; Tables S1 and S2).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“Conversely, rates of HBsAg loss and seroconversion were low at 2%–3%, and quantitative HBsAg titres declined minimally over 8 years.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“No patients developed resistance to TAF.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“The long-term PAGE-B cohort included 1,644 Caucasian patients with CHB treated with entecavir or tenofovir.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“The 10- and 15-year cumulative incidences of HBsAg loss on NA(s) were 8.3% and 14.3%, respectively; the IR of HBsAg loss increased from 0.94 before year 10 to 1.42/100 PYs after year 10 (p = 0.025).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“NA therapy was discontinued in 125 (7.6%) patients who remained HBsAg positive.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quoteCopyFlag

“Sustained suppression of HBV DNA is associated with an improvement in liver histology. After 5 years of treatment with ETV or tenofovir, improvement in liver fibrosis was observed in most patients and there was even reversal of Ishak F5/6 fibrosis/cirrhosis in some patients.” (opens the source at this quote in a new tab)CopyFlag

“many studies with follow-up periods of around 5 years likely had insufficient duration and sample sizes to demonstrate a significant effect on preventing HCC and death.” (opens the source at this quote in a new tab)CopyFlag

“However, one retrospective study with a follow-up of 8 years showed that TDF was associated with an HCC risk reduction of 73% in patients without cirrhosis.” (opens the source at this quote in a new tab)CopyFlag

“Improvement of survival: multiple studies, as summarised in a meta-analysis, have demonstrated a 50% reduction in mortality in patients with cirrhosis achieving viral suppression on NA therapy.” (opens the source at this quote in a new tab)CopyFlag