Conference Coverage

How to choose between highly effective HBV therapies


 

EXPERT ANALYSIS FROM GUILD 2018

– With three highly effective, guideline-recommended nucleoside/tide therapies for chronic hepatitis B virus (HBV) infection now available, the selection of the optimal antiviral agent for a given patient can seem daunting.

Norah Terrault, MD, offered guidance on this score at the Gastroenterology Updates, IBD, Liver Disease meeting.

Dr. Norah Terrault of UCSF Bruce Jancin/MDedge News

Dr. Norah Terrault

The three agents – the nucleoside inhibitor entecavir (Baraclude), nucleotide inhibitor tenofovir disoproxil fumarate (Viread), and nucleoside inhibitor tenofovir alafenamide (Vemlidy) – are all once-daily oral medications, and all have very low or no resistance reported to date.

As the current guidelines of the American Association for the Study of Liver Disease and European Association for the Study of the Liver make clear, these agents are to be used in targeting patients with active disease, defined by elevated alanine aminotransferase and HBV DNA levels and/or advanced fibrosis. These antivirals aim at long-term HBV control rather than disease cure.


Although numerous investigational drugs are in development with a focus on cure, the day of curative therapy has not yet arrived, noted Dr. Terrault, a professor of medicine and the director of the viral hepatitis center at the University of California, San Francisco.

Randomized trials presented at the 2017 annual meeting of European Association for the Study of the Liver demonstrated that the newest agent, tenofovir alafenamide (TAF), was as effective as tenofovir disoproxil fumarate (TDF) at suppressing HBV DNA through 96 weeks in both hepatitis B e-antigen (HBeAg)–negative and HBeAg-positive patients.

Moreover, TAF had a small but statistically significant advantage in terms of seroconversion rate at week 96 in the HBeAg-positive group, by a margin of 18%-12%. The alanine aminotransferase normalization rate was also significantly higher in the TAF group, by a margin of 81%-71% in HBeAg-negative patients and 75%-68% in HBeAg-positive patients.

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