IFN therapy offers some key advantages.

Treatment is for a fixed period, and if an adequate therapeutic response is achieved, no further treatment is required. IFN therapy can therefore produce lasting therapeutic benefits in the drug-free state. Furthermore, overseas studies have reported that IFN therapy is also highly effective at eliminating HBsAg over the long term. However, disadvantages include the fact that only 20–30% of HBeAg positive cases and 20–40% of HBeAg negative cases respond well to Peg-IFN treatment; patients are required to attend hospital weekly; there are several possible adverse reactions associated with treatment; and finally, Peg-IFN treatment for cirrhosis is not currently approved by Japanese national medical insurance. Meanwhile, NAs are a form of antiviral agent originally developed as a pharmacological therapy for human immunodeficiency virus (HIV). Once it was established that NAs also

hinder the reverse transcription selleck products mechanism in HBV proliferation, the use of lamivudine, adefovir and entecavir for hepatitis B was approved over the period 2000 to 2006. NAs have a powerful Obeticholic Acid inhibiting effect on HBV DNA proliferation, regardless of genotype, and act as antiviral agents and promote quiescence of hepatitis in nearly all patient types, including those of more advanced age with little prospect of spontaneous remission. In particular entecavir, currently the first-choice drug, has a very low incidence of resistant mutations compared to lamivudine,

and is highly effective at HBV DNA negative conversion and ALT normalization, irrespective of baseline factors. It has virtually no adverse reactions in the short term. On the other hand, it requires a lengthy administration period, due to the propensity for flare-up if treatment is withdrawn, increasing the likelihood of drug-resistant mutations and raising safety issues. Entecavir is also said to be less successful than IFN treatment in reducing the HBsAg load. Thus, Peg-IFN and entecavir have quite different pharmacological properties and cannot be compared directly, as shown in Table 3. In both HBeAg positive[8-21] and negative cases,[15, 22-26] Peg-IFN has been shown to be more effective in terms of the long term goal of HBsAg elimination, while entecavir is more effective Edoxaban in terms of the short-term goals of normalizing ALT and suppressing HBV DNA proliferation (see Tables 4, 5). Peg-IFN and entecavir also differ in terms of predictive factors for therapeutic efficacy, as shown in Table 6. It is therefore important that treatment of HBV should be tailored to the individual patient, based on a thorough understanding of the natural course of the disease and of the key differences between Peg-IFN and entecavir. Short term (<20,000 copies/mL) Long term (<10,000 copies/mL) Recommendations Peg-IFN and entecavir are substantially different pharmacotherapeutic agents that do not bear direct comparison.