Unmet need in chronic hepatitis B management
Despite all these exciting developments, there remain some unmet needs in the management for patients with chronic hepatitis B (CHB). As majority of CHB patients are going to use oral nucleos(t)ide analogues (NAs) for decades, Safety profile of NAs is of no doubt an important issue. The newest nucle...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Association for the Study of the Liver
2019-03-01
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| Series: | Clinical and Molecular Hepatology |
| Subjects: | |
| Online Access: | http://e-cmh.org/upload/pdf/cmh-2018-0106.pdf |
| _version_ | 1818559029426782208 |
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| author | Lilian Yan Liang Grace Lai-Hung Wong |
| author_facet | Lilian Yan Liang Grace Lai-Hung Wong |
| author_sort | Lilian Yan Liang |
| collection | DOAJ |
| description | Despite all these exciting developments, there remain some unmet needs in the management for patients with chronic hepatitis B (CHB). As majority of CHB patients are going to use oral nucleos(t)ide analogues (NAs) for decades, Safety profile of NAs is of no doubt an important issue. The newest nucleotide analogue tenofovir alafenamide is potent in terms of viral suppression, together with favourable renal and bone safety profile. Biochemical response as reflected by alanine aminotransferase (ALT) normalization is recently found to be prognostically important. Patients who achieved ALT normalization have reduced the risk of hepatic events by 49%. Functional cure as reflected by hepatitis B surface antigen seroclearance not only implies patients may stop NA treatment, it also confers to a reduced risk of hepatocellular carcinoma and other hepatic events. Hence functional cure should be the ultimate treatment goal in CHB patients. Preemptive antiviral treatment may reduce mother-to-child transmission of hepatitis B virus, especially if birth dose of vaccination cannot be given in the first two hours after delivery. Lastly, despite the currently first-line NAs have high-genetic barrier to drug resistance mutations, there are still are many patients who were previously treated with low barrier of resistance including lamivudine, telbivudine or adefovir dipivoxil which could lead to antiviral resistance and affecting the choice of NAs. |
| first_indexed | 2024-12-14T00:20:01Z |
| format | Article |
| id | doaj.art-aec1c6cf3b0947ecb8ec99472da78f45 |
| institution | Directory Open Access Journal |
| issn | 2287-2728 2287-285X |
| language | English |
| last_indexed | 2024-12-14T00:20:01Z |
| publishDate | 2019-03-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj.art-aec1c6cf3b0947ecb8ec99472da78f452022-12-21T23:25:16ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2019-03-0125217218010.3350/cmh.2018.01061447Unmet need in chronic hepatitis B managementLilian Yan Liang0Grace Lai-Hung Wong Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, ChinaDespite all these exciting developments, there remain some unmet needs in the management for patients with chronic hepatitis B (CHB). As majority of CHB patients are going to use oral nucleos(t)ide analogues (NAs) for decades, Safety profile of NAs is of no doubt an important issue. The newest nucleotide analogue tenofovir alafenamide is potent in terms of viral suppression, together with favourable renal and bone safety profile. Biochemical response as reflected by alanine aminotransferase (ALT) normalization is recently found to be prognostically important. Patients who achieved ALT normalization have reduced the risk of hepatic events by 49%. Functional cure as reflected by hepatitis B surface antigen seroclearance not only implies patients may stop NA treatment, it also confers to a reduced risk of hepatocellular carcinoma and other hepatic events. Hence functional cure should be the ultimate treatment goal in CHB patients. Preemptive antiviral treatment may reduce mother-to-child transmission of hepatitis B virus, especially if birth dose of vaccination cannot be given in the first two hours after delivery. Lastly, despite the currently first-line NAs have high-genetic barrier to drug resistance mutations, there are still are many patients who were previously treated with low barrier of resistance including lamivudine, telbivudine or adefovir dipivoxil which could lead to antiviral resistance and affecting the choice of NAs.http://e-cmh.org/upload/pdf/cmh-2018-0106.pdfHepatitis BCirrhosisHepatocellular carcinomaMortalityTenofovir alafenamide |
| spellingShingle | Lilian Yan Liang Grace Lai-Hung Wong Unmet need in chronic hepatitis B management Clinical and Molecular Hepatology Hepatitis B Cirrhosis Hepatocellular carcinoma Mortality Tenofovir alafenamide |
| title | Unmet need in chronic hepatitis B management |
| title_full | Unmet need in chronic hepatitis B management |
| title_fullStr | Unmet need in chronic hepatitis B management |
| title_full_unstemmed | Unmet need in chronic hepatitis B management |
| title_short | Unmet need in chronic hepatitis B management |
| title_sort | unmet need in chronic hepatitis b management |
| topic | Hepatitis B Cirrhosis Hepatocellular carcinoma Mortality Tenofovir alafenamide |
| url | http://e-cmh.org/upload/pdf/cmh-2018-0106.pdf |
| work_keys_str_mv | AT lilianyanliang unmetneedinchronichepatitisbmanagement AT gracelaihungwong unmetneedinchronichepatitisbmanagement |