Prediction of Response to Immune Modifying Therapy for Patients with Chronic Hepatitis B using Hepatitis B Surface Antigen Levels
Year: 2011
Type: dissertation
Abstract: The treatment of chronic hepatitis B has greatly improved with the\\nintroduction of potent nucleos(t)ide analogues with a high barrier to\\nresistance and peginterferon. The advantages and limitations of both\\ntreatment options should be considered when a patient has an indication to\\ninitiate antiviral therapy. Nucleos(t)ide analogues can be prescribed to\\nall patients in whom treatment is indicated and offer easy daily oral\\ndosing, are well tolerated and able to maintain suppression of viral\\nreplication for prolonged periods of time. However, a sustained\\noff-treatment response is unlikely. A sustained response is more likely to\\nbe achieved in a subgroup of patients with a finite course of\\npeginterferon therapy. Furthermore, sustained responders to peginterferon\\nexperience a strong degree of serum hepatitis B surface antigen (HBsAg)\\ndecline resulting in a higher rate of HBsAg clearance.\\nBoth peginterferon and nucleos(t)ide analogues can be given as first-line\\ntreatment option for chronic hepatitis B. However, peginterferon should\\nonly be considered for patients with a high chance of response because of\\nthe considerable side effects associated with this agent. Predictors of\\nresponse at baseline, such as hepatitis B virus (HBV) genotype, alanine\\naminotransferase and HBV DNA levels, aid in selecting patients for\\npeginterferon therapy, especially in hepatitis B e antigen\\n(HBeAg-)positive disease. Furthermore, on-treatment viral markers, in\\nparticular quantitative HBV DNA and HBsAg, allow the identification of\\npatients who are unlikely to benefit from peginterferon early during the\\ntreatment course, thereby avoiding unnecessary treatment. Patients who are\\nnot eligible for peginterferon or who have a low probability of response\\nto peginterferon based on baseline or on-treatment factors should be\\nadvised to initiate or switch to nucleos(t)ide analogue therapy
Author: Vincent Rijckborst
Language: English
Topic: Hepatitis B Virus Studies
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2164317966