Three common misconceptions in oral antiviral therapy for hepatitis B

Myth 1: Irregular discontinuation of medication Phenomenon 1: Before starting the medication, you only focus on whether you can stop it as soon as possible. Phenomenon 2: Taking drug cessation as the treatment goal and stopping the drug on your own when the test indexes improve slightly. Both foreign and Chinese hepatitis B prevention and treatment guidelines clearly state that the goal of hepatitis B antiviral treatment is to delay disease progression and reduce the occurrence of cirrhosis and liver cancer, which is the fundamental purpose of hepatitis B antiviral treatment. Regarding the issue of drug discontinuation, the latest version of the 2010 Guidelines for the Prevention and Treatment of Chronic Hepatitis B clearly states that among patients on oral antiviral therapy, the total course of treatment should be at least 2 years for patients with major triplets and 2.5 years for patients with minor triplets, and that the longer the course of treatment, the lower the relapse rate. A recent study of 10,000 people in China showed that 52% of oral antiviral patients discontinued their medication, and 57% of those who discontinued their medication had their disease worsened. Myth 2: Change medication at will Phenomenon 1: During treatment, change medication on your own because you are worried about drug resistance. Phenomenon 2: When you hear others say that the effect of which drug is good, you change the drug by yourself. First of all, hepatitis B treatment medication should be standardized and should be used under the advice of a doctor. Secondly, several oral antiviral drugs currently on the market are effective, but most of them have cross-resistance, and switching back and forth between single drugs may lead to the occurrence of multiple drug resistance. At present, more and more clinical data at home and abroad confirm that six months is a critical point in the process of oral antiviral therapy. For example, if lamivudine is chosen at the beginning of treatment and tested at six months of treatment, if the HBV DNA level is not measurable at that time, it means that the effect is good and lamivudine monotherapy can be continued; if the HBV DNA level is still measurable although it has decreased, it means that the efficacy is not good. Adding a drug with a different resistance site (adefovir) on top of the original drug is significantly better than changing the drug in terms of therapeutic effect and long-term resistance rate. Myth 3: Excessive fear of drug resistance Phenomenon 1: “Choking on drugs”: refusing to use any oral antiviral drugs due to excessive fear of drug resistance, which leads to disease progression. Phenomenon 2: “Drug resistance is paramount”: With the fever of drug resistance theory in recent years, many patients who have just started treatment for hepatitis B only look at the rate of drug resistance when choosing drugs, without considering other treatment factors, which leads to giving up treatment or having to change drugs in the course of long-term treatment because of economic and side effects, leading instead to the progression of disease or drug resistance The rate of drug resistance increases. First of all, drug resistance is common to several oral anti-hepatitis B viral drugs that have been marketed so far, and all oral anti-hepatitis B viral drugs may produce drug resistance. Even if resistance emerges, virological suppression can be regained through salvage therapy. Secondly, for patients with chronic hepatitis B who are about to be treated with oral antiviral drugs, the long-term nature of antihepatitis B virus treatment should be clarified before selecting the drug, and the choice of the drug should be made in terms of economy, drug safety, and whether to delay disease progression.