Drugs to treat hepatitis B may not prevent patients from liver disease later
Research Activities, August 2011, No. 372
Chronic hepatitis B can result in liver damage, failure, or cancer and causes 2,000 to 4,000 deaths each year, according to the Centers for Disease Control and Prevention. Antiviral drugs are often prescribed to combat the disease progression, but hard evidence on their effectiveness is lacking.
Researchers at the Minnesota Evidence-based Practice Center reviewed randomized control trials to examine the benefits and harms of antiviral therapy to treat hepatitis B. They found no evidence that a single antiviral drug reduced mortality or prevented the development of liver cancer or cirrhosis. Physicians and patients should make treatment decisions based on the benefits of antiviral drugs on biochemical, virologic, and histologic laboratory markers as well as safety of the drugs, suggest the study authors. They found that no one drug regimen improved all laboratory markers. Interferon alfa-2b and peginterferon alfa-2b, which are interferon therapies that are given by injection (usually for less than a year), appear to cause the loss of hepatitis B surface antigen, which is one marker for resolved hepatitis B. However, 50 percent of patients who receive interferon therapy suffer flu-like symptoms that include fatigue, headache, abdominal pain, nausea, and diarrhea. All treatments decreased hepatitis B virus DNA levels, including oral medications such as lamivudine, telbivudine, adefovir, and entecavir. However, most of the included studies excluded patients with liver or renal insufficiency or other serious coexisting conditions.
Using pooled data from the studies, the authors created an evidence map for clinicians to use when treating patients diagnosed with hepatitis B. The map provides data on efficacy and the comparative effectiveness of the different treatments, including benefits and harms, and identifies knowledge gaps. This study was funded by the Agency for Healthcare Research and Quality (Contract No. 290-02-0009) through an inter-agency agreement with the National Institutes of Health Office of Medical Applications of Research.
See "Systematic review of the literature on comparative effectiveness of antiviral treatments for chronic hepatitis B infection," by Tatyana A. Shamliyan, M.D., M.S., James R. Johnson, M.D., Roderick MacDonald, M.S., and others in the March 2011 Journal of General Internal Medicine, 26(3); pp. 326-339.