Enhancing Interferon Treatment for Chronic Hepatitis B with Baraclude

Q: Enhancing Interferon Treatment for Chronic Hepatitis B with Baraclude

Hello, Sir： <br>Q1 Combination therapy is a recommendation based on professional experience, and while it is not inappropriate, there are currently no definitive human trial results to support it. <br>Therefore, it is unclear what the best combination would be. <br><br>Q2 There w

The efficacy of interferon combined with Bevacizumab?

Hello, Doctor.
I am a carrier of hepatitis B and have been regularly undergoing ultrasound and blood tests for a long time.
However, since November of last year, my liver enzyme levels have been rising to over 200, and my surface antigen level is at 80,000.
My attending physician suggested starting treatment with interferon.
After three months of treatment, I had my blood tested to evaluate the effectiveness, and the results showed that my surface antigen dropped from 80,000 to 50,000 and now to 20,000.
The original target was to reduce it to 8,000, but my liver enzyme levels have risen to over 300.

Q1: The doctor mentioned that interferon is showing some effect, but not enough, and that I need to combine it with oral Baraclude (entecavir) to enhance the treatment efficacy.
Is this treatment approach acceptable?
Q2: If I take Baraclude for three months and then stop, will there be a risk of developing drug resistance?
Q3: What specific data or parameters indicate that the treatment for hepatitis B virus is effective?

Ma, 40~49 year old female. Ask Date: 2016/02/25

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Sir:
Q1 Combination therapy is a recommendation based on professional experience, and while it is not inappropriate, there are currently no definitive human trial results to support it.
Therefore, it is unclear what the best combination would be.

Q2 There will be no resistance to Beclomethasone.

Q3 If the virus is undetectable, it indicates adequate control (but stopping the medication may lead to relapse).
If the antigen is undetectable, it suggests a long-term cure (but achieving this goal is quite challenging).

Changhua Hospital cares about your health.

Chen Shih-Tien

Reply Date: 2016/02/25

More Info

Hello! Thank you for your detailed questions regarding the treatment of chronic Hepatitis B (HBV) and the potential use of Baraclude (entecavir) alongside interferon therapy. Let's address your concerns one by one.

Q1: Is it okay to combine interferon with Baraclude for treatment?
Combining interferon with antiviral medications like Baraclude can be a reasonable approach in certain cases, especially when the response to interferon alone is not satisfactory. Interferon is an immunomodulatory treatment that can help the immune system to fight the virus, while Baraclude is a potent antiviral that directly inhibits HBV replication. The rationale behind this combination is to enhance the overall antiviral effect, potentially leading to better outcomes in terms of viral suppression and liver function improvement.

However, the decision to use this combination should be made by your healthcare provider based on your specific clinical situation, including your liver function tests, viral load, and overall health status. It's important to monitor your liver function and viral load closely during this combination therapy to assess its effectiveness and adjust treatment as necessary.

Q2: Will stopping Baraclude after three months lead to resistance?
The concern about developing resistance to antiviral medications like Baraclude is valid, especially if the medication is not taken consistently or is stopped prematurely. Entecavir has a high barrier to resistance, meaning that it is less likely to lead to resistant strains of the virus compared to other antiviral medications. However, if you stop taking it after only three months, there is a risk that the virus could rebound or develop resistance, particularly if the virus was not fully suppressed during that time.

It is crucial to follow your doctor's recommendations regarding the duration of treatment. If your doctor prescribes Baraclude for a specific duration, it is generally advisable to complete the course to minimize the risk of resistance and ensure the best possible outcome.

Q3: What are the target values for effective treatment of HBV?
Effective treatment of chronic Hepatitis B is typically assessed through several parameters, including:
1. HBsAg Levels: A significant reduction in HBsAg (Hepatitis B surface antigen) levels is a positive indicator. The goal is often to achieve an HBsAg level below 1000 IU/mL, and ideally, to achieve seroconversion (loss of HBsAg and development of anti-HBs antibodies).

2. HBV DNA Levels: The viral load (HBV DNA) should ideally be undetectable or at very low levels (below 20 IU/mL) to indicate effective suppression of the virus.

3. Liver Function Tests: Improvement in liver enzymes (ALT and AST) is also a critical marker of treatment success. Normalization of these enzymes indicates reduced liver inflammation.

4. Liver Histology: In some cases, a liver biopsy may be performed to assess the degree of liver inflammation and fibrosis, which can provide additional information on treatment effectiveness.

In summary, the combination of interferon and Baraclude can be a viable treatment strategy for chronic Hepatitis B, especially if initial responses to interferon are inadequate. However, it is essential to adhere to the prescribed treatment regimen to minimize the risk of resistance and achieve the best possible outcomes. Regular follow-up with your healthcare provider is crucial to monitor your progress and make any necessary adjustments to your treatment plan. Always consult your physician before making any changes to your treatment. Thank you for your questions, and I wish you the best in your treatment journey!

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