Reviews for APASL guidelines: immunomodulator therapy of chronic hepatitis B

Abstract

The primary aim of immunomodulator therapy is to help the natural human immune system to mount a defense against hepatitis B virus. IFN-a has been used for the treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B for over two decades and has been shown to be effective in suppressing HBV replication and in inducing serological response leading to long-term clinical benefits. IFN-a has been used in patients with wellcompensated cirrhosis with comparable or better response to that in non-cirrhotic patients. IFN-a therapy in patients with cirrhosis has a similar side effect profile as in those without cirrhosis. However, IFN-a is contraindicated in patients with overt or decompensated cirrhosis. Pegylated IFN-a has been shown to be effective in treatment of chronic hepatitis B with sustained response rate in about one-third of the treated patients. Peg IFN-a treatment in non-responders to lamivudine or adefovir dipivoxil showed similar response rate to that seen in naïve patients. Thymosin a 1 is effective in treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B with a significantly increasing virological response over time after therapy.

Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update

“…Retreatment of relapsed patients with IFN-a showed a response rate of 20-40%. When HBeAg seroconversion to anti-HBe is achieved, it is sustained in more than 80% of cases [41].…”

“…However, IFN treatment is usually associated with adverse effects, especially influenza-like symptoms, fatigue, neutropenia, thrombocytopenia, and depression. These are usually tolerable, but may require dose modification and premature cessation of treatment [41].…”

Thymosin alpha 1: Biological activities, applications and genetic engineering production

“…Chronic HBV infection is a serious clinical problem because of its worldwide distribution and potential adverse sequelae, such as cirrhosis and hepatocellular carcinoma [44]. T␣1 has been approved for the treatment of hepatitis B in many countries worldwide with a significantly increasing virological response over time after therapy [58]. Most of the studies have evaluated the efficacy of T␣1 in the treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B.…”

Polymorphisms of CYP27B1 are associated with IFN efficacy in HBeAg‐positive patients

“…Moreover, the cost of PEG-IFN was higher. 4 After PEG-IFN treatment, most patients obtained sustained virological response, HBeAg seroconversion with or without HBsAg clearance.…”

“…However, IFN therapy may cause several side‐effects such as influenza‐like symptoms, fatigue, neutropenia, and thrombocytopenia during treatment. Moreover, the cost of PEG‐IFN was higher . After PEG‐IFN treatment, most patients obtained sustained virological response, HBeAg seroconversion with or without HBsAg clearance.…”