Entecavir is currently the best oral antiviral drug among the hepatitis B drugs (mainly refers to the lowest risk of drug resistance), of course, is also one of the most expensive oral antiviral drugs on the market, the recent listing of domestic generic products, the price is much cheaper, many patients with this drug, with the crowd has become more and more, here I say a few words on the use of entecavir and attention to problems, so as not to cause errors in the use The first thing that I want to do is to talk about the advantages of this drug. First of all, the advantages of this drug: 1, the strongest antiviral effect. It is currently the strongest antiviral drug, the ability to inhibit the virus is higher than Adefovir by more than 10 times, so it is suitable for all people with different viral loads, most patients can quickly turn negative within 6 months, so the ability to control the disease is the strongest. 2. Lowest risk of drug resistance . Drug resistance (also known as viral mutation) is a common disadvantage of all oral antivirals, including entecavir. However, entecavir has the lowest resistance of all antiviral drugs and is the least likely to develop viral mutation, with a very encouraging 6-year risk of resistance of only 1.2%. So far, since this drug has been available, I have not found a single case of resistance in hundreds of hepatitis B patients I have actively prescribed, which of course may be related to my strict grasp of indications. The main reason is that this drug has the highest resistance barrier and the strongest ability to reduce the virus, especially for patients who are on long-term medication and can’t stop, including older, comorbid, immune, cirrhotic ascites and other people. 3.Low side effects. Entecavir has low side effects, very low gastrointestinal reactions, and can be tolerated for a long time. Some years ago it was thought that entecavir could lead to tumorigenesis, so far there is no evidence of such a role, but of course pregnant women are contraindicated. 4. Wide range of applicable population. It is suitable for all adult population, those who do not need to have children and long-term treatment, especially those who are above S2, with normal liver function and good economic condition. The effect of controlling the progression of cirrhosis and inhibiting the occurrence of liver cancer are good. Next, the disadvantages: 1. Expensive. No matter domestic or imported, they are all relatively expensive. If you take the medicine to more than 5~8 years, it will be a relatively large expense, especially for poor liver disease patients. Therefore, people with poor economic conditions should not consider using this drug, in general, the medication is not allowed to interchange back and forth: mainly because of the current limited anti-disease drugs, multiple drug changes are easy to cause drug resistance, discontinuation of the drug will cause liver deterioration, no drug available is the biggest problem, must be measured. 2, taking inconvenience. Requirement to take on an empty stomach, generally do not take with food, tea or other drugs in combination, before and after taking this drug fasting 4 hours. Sometimes this can also turn out to be an advantage, which allows patients to develop good habits and quit smoking and drinking, which is so needed for patients with liver disease. 3. The seroconversion rate is low. From the current international research, this drug seroconversion rate seems to be relatively low, resulting in the desire to short-term discontinuation (3-5 years) is more difficult, my patients are also such, so this drug is more suitable for long-term maintenance treatment is better. Of course, if there is E antigen seroconversion, surface antigen reduction or long term viral negativity (CCCDNA depletion), it is possible to discontinue the drug. If there is no economic pressure, if long-term use, due to the lowest risk of drug resistance, the possibility of cccDNA depletion is the largest of several drugs, the chances of long-term discontinuation (more than 5-8 years) may be greater. 4, ALT repeatedly or poor response population is larger. After taking the drug, ALT is likely to rise, probably due to the strong antiviral ability of the drug, but generally belong to the transient elevation, 2-3 months can generally be automatically normal. After discontinuation, liver function can deteriorate, as with other antivirals. The number of people with poor response is also high: if the drug is ineffective after 3 months, it is recommended to change the drug; if the response is poor after 1 year, it is recommended to double the drug or to add ADV. Generally, it should not be used in patients with severe hepatitis (2011 American Liver Association proposed a new view). The indications for entecavir are as follows: 1. people with good economic conditions and married with children. 2, people with cirrhosis, especially those with normal liver function. 3, people who need to take the drug for a long time, people who can’t stop taking the drug, including people with low immunity and comorbidities. 4, Adefovir-resistant people. The side effects of entecavir are actually detailed in the instructions for entecavir, and it is recommended that sufferers read them carefully before using entecavir with this drug. The actual side effects of entecavir are not only a result of the fact that the drug is not available in the market, but also a result of the fact that the drug is available in the market. 1, on the issue of tumorigenesis: because in animal experiments, found to have tumorigenic effect, after 7-8 years of international multi-center research found that this side effect can basically be denied. 2, about the emergence of kidney damage, CK and lactate elevation: kidney damage is basically rare, much lower than ADV; CK elevation is also lower than TBV and LAM; lactate elevation and muscle lysis, weakness and other rare complications are common to several nucleoside analogues, including TBV, LAM and ADV here, but the overall incidence is low, but in HIV patients may be more common, mainly The main reason is related to human mitochondrial damage. 3, about other reactions, such as hair loss, gastrointestinal reactions are rare. 4, not easy to ignore the side effects: is not to meet the criteria for discontinuation, self-medication or intermittent discontinuation of the problem, more common, may lead to recurrent hepatitis and liver failure, the proportion is much higher than the probability of those other side effects, this must be noted, especially in patients with combined cirrhosis. 5. Changing to ETV after having used other drugs such as LAM or ADV will greatly affect the efficacy of ETV. If you need to replace it, the sooner the better. 6, this drug has the risk of fetal malformation in animal experiments, generally not allowed to use in pregnant women; of course, there is no international expert consensus on whether men can use after pregnancy, but there is one thing, certainly less than the impact of women, of course, or safety is the first. Entecavir combination therapy: 1, Entecavir combined with interferon therapy: the initial combination of interferon, can make a large increase in the rate of viral conversion, but the overall seroconversion increase is limited, the patient benefit is relatively limited, therefore not recommended by any domestic and foreign hepatitis B guidelines. But how to sequential combination, or domestic and foreign research direction, there is no consensus. 2, Entecavir combined with ADV: For people with ADV or ETV resistance or poor response, effective remedial treatment regimens are unanimously recommended at home and abroad. 3, ETV combined with TBV or LAM: At present, this combination can not increase the efficacy, and can increase side effects and drug resistance, generally are not recommended.