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Reverse-transcriptase inhibitors for chronic hepatitis B


The antiviral reverse-transcriptase inhibitors entecavir, tenofovir alafenamide and tenofovir disoproxil are recommended as the treatment of first choice for chronic hepatitis B. The objective of the treatment is to prevent hepatocellular carcinoma. Since complete cure is usually impossible (unlike the situation for hepatitis C), the reverse-transcriptase inhibitors may have to be taken for a very long period, or even for life. Research has shown that entecavir, tenofovir alafenamide and tenofovir disoproxil appear to differ little in terms of virological response and effectiveness regarding the reduction of the risk of hepatocellular carcinoma.

  • The results of a meta-analysis of randomised and observational studies do not allow a clear conclusion to be drawn regarding a difference in virological response between tenofovir disoproxil and entecavir, or between tenofovir disoproxil and tenofovir alafenamide.
  • Only limited conclusions can be drawn regarding a difference in the reduction of the risk of hepatocellular carcinoma as a complication of hepatitis B, as only cohort studies have been published about tenofovir disoproxil, entecavir and the older drugs adefovir and lamivudine.
  • Tenofovir disoproxil and entecavir appear to reduce the risk of hepatocellular carcinoma to a greater extent than the older reverse-transcriptase inhibitors adefovir and lamivudine; there appears to be no difference between tenofovir disoproxil and entecavir.

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Authors

  • Leo M.L. Stolk, dr