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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 18, 2015; 7(23): 2427-2431
Published online Oct 18, 2015. doi: 10.4254/wjh.v7.i23.2427
Antiviral therapy for chronic hepatitis B: Combination of nucleoside analogs and interferon
Satoru Hagiwara, Naoshi Nishida, Masatoshi Kudo
Satoru Hagiwara, Naoshi Nishida, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
Author contributions: Hagiwara S drafted the manuscript and wrote the final version; Nishida N revised the manuscript; Nishida N and Kudo M approved the final version of the manuscript.
Supported by Grant-in-Aid for Scientific Research (in part, KAKENHI: 24590997) from the Japanese Society for the Promotion of Science (to Nishida N); and a grant from the Smoking Research Foundation (to Nishida N).
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naoshi Nishida, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. naoshi@med.kindai.ac.jp
Telephone: +81-723-660221-3525 Fax: +81-723-670288
Received: May 13, 2015
Peer-review started: May 15, 2015
First decision: June 2, 2015
Revised: June 18, 2015
Accepted: September 14, 2015
Article in press: September 21, 2015
Published online: October 18, 2015
Processing time: 159 Days and 14.5 Hours
Abstract

The ideal goal of chronic hepatitis B (CHB) treatment should be suppression of emergence of hepatocellular carcinoma through the disappearance of hepatitis B s antigen (HBsAg) rather than the control of serum hepatitis B virus-DNA level. For this purpose, various types of combination therapies using nucleoside analogs (NAs) and interferon (IFN) have been conducted. The therapeutic effects of combination of two different kinds of agents are better than those of the monotherapy using NAs or IFN alone, probably because different pharmaceutical properties might act in a coordinated manner. Recently, combination therapies with NAs and IFN and sequential therapies with NAs administration followed by IFN therapy have been routinely employed. We previously reported that combination therapy using entecavir (ETV) and pegylated (PEG)-IFN showed antiviral effects in 71% of CHB patients; the effect of this combination was better than that using lamivudine (LAM) and PEG-IFN. This is partially explained by the better antiviral effects of ETV than those of LAM. In our analysis, the cohort of CHB consisted of the patients who showed a flare-up of hepatitis before antiviral therapy, and their baseline HBsAg levels were relatively low. Therefore, in addition to the combination of the agents, the appropriate selection of patients is critical to achieve a good viral response.

Keywords: Hepatitis B virus; Interferon; Sequential therapy; Combination therapy; Nucleoside analog

Core tip: For the suppression of emergence of hepatocellular carcinoma, disappearance of hepatitis B s antigen (HBsAg) is necessary, which is an important goal for the treatment of chronic hepatitis B. In order to achieve HBsAg clearance, combination therapies with nucleoside analogs (NAs) and interferon (IFN) and sequential therapies with NAs administration followed by IFN therapy have been routinely employed. The combination of antiviral agents, and the appropriate selection of patients are critical to obtain a good response for HBsAg clearance.