Treatment for Hepatitis B

[krishnan R.S.]

Please inform what are the FDA approved injections available for treatment of Hepatitis B.  And what
is the course of treatment and its approximate cost.

[lexman]

http://www.pegasys.com/

http://www.schering-plough.com/schering_plough/pc/hepatitis.jsp

[lexman]

1. Interferon alpha (IFN) - approved 1991. In 1993, a meta analysis showed that with interferon alpha there was 8% loss of hepatitis B surface antigen, 33% loss of e-antigen (not seroconversion, though), and 37% undetectable HBV DNA (but in 1993 the cut-off for undetectable DNA was <10 6, which is higher than today because tests are now more sensitive).

2. PEG INTERFERON (PEG) – approved May 2005

* With PEG, 32% of eAg positive patients had suppression of viral DNA <100,000 copies and 41% had normalization of ALT. With combination PEG and LAM, eAg seroconversion occurred in 27% and there was 34% DNA suppression. From this data, it appears there is no real advantage for combination treatment with PEG and LAM for e-antigen positive patients. This will probably be the same case with other oral antivirals (according to a study reported by G. Lau in Hepatology 2004).
    * Combination of PEG and LAM in eAg negative patients is no better than monotherapy with PEG. With PEG alone, there was 43% DNA suppression <20,000 copies and 59% normalization of ALT. With combination therapy, there was 44% DNA suppression and 60% normalization of ALT (according to a study reported by Marcellin in the New England J. of Medicine 2004).
    * With PEG, e-antigen loss by Genotype: A = 47%, B=44%, C = 28%, D = 25%
    * Appears there is a greater chance of hepatitis B surface antigen loss in eAg positive patients with PEG than with LAM (3-7% with PEG, and 0-<1% with LAM). But there was no difference between PEG alone or in combination with LAM (according to three different studies by Janssen, Marcellin and Lau).