Choosing the Best Treatment for Chronic Hepatitis B: Interferon vs. New Oral Antivirals

Regarding interferon therapy?

Hello: I have been undergoing treatment for hepatitis B for over three years.
Initially, I was treated with interferon, and there was a period when my AST and ALT levels dropped to normal (although the e-antigen remained positive, and the viral load decreased from 1950 to 38).
After a year of follow-up treatment, my AST and ALT levels stabilized around 70 and 100, respectively, while the e-antigen remained positive.
My physician advised me to stop the medication to avoid the development of hepatitis B mutant viruses, and then to continue monitoring (with blood tests every three months and abdominal ultrasounds every six months) to see if my body can produce antibodies on its own (PS: without a continuous rise in AST and ALT...).
Last week, I had another blood test, and my AST was 166, ALT was 286, and the e-antigen remained positive.
The doctor asked if I would consider interferon treatment (administered weekly for six months) or new oral antiviral medications, both of which would be out-of-pocket expenses.
I would like to understand which option is the best for me, as I am not familiar with the new oral antiviral medications and cannot comprehend medical articles.

Kunrao, 20~29 year old female. Ask Date: 2005/01/09

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! Recently, your GPT index has increased.
Besides Danazol, long-acting interferons are also one of the treatment options.
However, they are currently not covered by health insurance and must be paid for out-of-pocket.
The efficacy of both treatments is quite similar, but for patients, interferons are administered via injection, which can be more challenging and may cause some side effects that can be uncomfortable.
The advantage is that they do not lead to drug resistance.
Therefore, after evaluating your options, you can choose the method that is most suitable for you.

Reply Date: 2005/01/09

More Info

When it comes to managing chronic Hepatitis B, the choice between interferon therapy and newer oral antiviral medications can be quite complex, especially for patients who have been undergoing treatment for an extended period. Based on your situation, where you have been treated with adefovir (干安能) and have seen some initial success followed by a plateau in liver enzyme levels, it is crucial to weigh the benefits and drawbacks of both treatment options.

Interferon Therapy:
Interferon is an immune-modulating therapy that can help the body fight off the Hepatitis B virus (HBV). It is typically administered via injection and can be effective in achieving a sustained virological response, particularly in patients who are e-antigen positive. However, interferon therapy is associated with a range of side effects, including flu-like symptoms, fatigue, depression, and potential impacts on thyroid function. The treatment duration is usually around six months to a year, and while some patients achieve a functional cure, others may not respond adequately.

Given your current situation with elevated GOT and GPT levels and persistent e-antigen positivity, interferon could be a viable option. However, the likelihood of achieving a sustained response may depend on various factors, including your overall health, liver function, and the specific characteristics of the virus you are dealing with.

New Oral Antivirals:
On the other hand, newer oral antiviral medications, such as tenofovir and entecavir, have become the mainstay of treatment for chronic Hepatitis B due to their high efficacy, safety profile, and ease of administration. These medications work by directly inhibiting viral replication, leading to a decrease in viral load and improvement in liver function tests over time. They are generally well-tolerated, with fewer side effects compared to interferon.

In your case, considering that you have already experienced some success with adefovir, switching to a more potent antiviral like tenofovir may be beneficial. Tenofovir is particularly effective against HBV and is less likely to lead to the development of drug-resistant strains of the virus. The decision to switch to a new oral antiviral should be based on your current liver function, the presence of any resistance mutations, and your overall treatment goals.

Considerations for Treatment Choice:
1. Efficacy: Newer oral antivirals have shown higher rates of viral suppression compared to interferon, especially in patients with e-antigen positivity.

2. Side Effects: If you have concerns about the side effects of interferon, oral antivirals may be a more suitable option.

3. Monitoring: Regardless of the treatment chosen, regular monitoring of liver function tests and viral load is essential to assess treatment efficacy and make necessary adjustments.

4. Resistance: If there is a concern about the development of resistance to adefovir, transitioning to a different antiviral may help mitigate this risk.

In conclusion, both interferon and newer oral antivirals have their place in the treatment of chronic Hepatitis B. The choice should be tailored to your specific circumstances, taking into account your treatment history, current liver function, and personal preferences. Discussing these options thoroughly with your healthcare provider will help you make an informed decision that aligns with your health goals.

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