Interferon Alone Effective for Hepatitis B
Some Patients May Do as Well With Single Drug Rather Than Combination
Virus Type Matters
The study by Janssen and colleagues is one of the first to suggest that the genetic makeup (genotype) of the virus helps predict treatment outcome. It's well known that genotype affects hepatitis C treatment, but that has not been thought to be important in hepatitis B.
Response rates among patients with genotypes A and B averaged 45%, compared with about 27% among patients with genotypes C and D. The A and B genotypes are more common among whites, while C and D genotypes are more commonly seen in Asian populations.
"This is the first prospective evidence indicating that genotype is an important predictor of treatment response for hepatitis B in the same way that it is for hepatitis C," Janssen says.
What the Experts Say
While the international study suggests that single-drug treatment with pegylated interferon is the most effective available treatment, two hepatitis B experts contacted by WebMD say it may not be the best choice for all patients.
Columbia University's Howard Worman, MD, who has written several books on hepatitis treatment, says many patients are not able to tolerate the side effects of interferon treatment. Epivir and the similar hepatitis B drug Hepsera have few side effects and are taken by mouth instead of by injection.
"When you are considering individual patients you have to weigh response rates vs. the ability to tolerate interferon," he says. "You can't make a blanket statement that pegylated interferon is the best treatment for every patient."
Eugene Schiff, MD, added that combination treatment with pegylated interferon and either Epivir or Hepsera might confer treatment advantages that were not evident in the study. Patients who got the combined therapy were taken off both pegylated interferon and Epivir after one year. Schiff says in clinical practice patients would probably be kept on Epivir if they were still responding to it.
"It is possible that the combined treatment group would have ended up with an ever-higher sustained response if they had been kept on [Epivir] or switched to [Hepsera] if resistance occurred," he says.
But Schiff says the evidence is building that pegylated interferon will play a major role in the treatment of patients with chronic hepatitis B infection.
"If we continue to see data that is this persuasive, I think that even physicians who currently use other drugs to treat hepatitis B will be much more likely to use interferon," he says.