Anti-hepatitis B virus drugs approved so far are common interferon (there are a variety of domestic commodities) and pegylated interferon (long-acting preparations, there are 2 trade names are Pyroxin and with Lakonnen); there are 4 nucleoside analogues (lamivudine, adefovir, entecavir and telbivudine, the corresponding trade names are Heptin, Haverix, Boludin and Sulbivir). China’s pharmaceutical market is in the process of consolidation, some drugs are advertised before they are approved; some drugs have been approved as antiviral drugs although they have been approved according to liver protection; hepatitis B vaccine is used for prevention but not approved for treatment. Moreover, patients who have used these drugs know that there is no antiviral effect. A regulated hospital and a regulated doctor may only use regulated drugs. What are the advantages and disadvantages of each of the two classes of anti-hepatitis B virus drugs? There are currently two very different classes of anti-hepatitis B virus drugs: interferon injections and nucleoside analogues of oral drugs. Nucleoside analogs have a direct inhibitory effect on the hepatitis B virus; interferon also has an antiviral effect, but is primarily an immunomodulatory agent. Nucleoside analogs have strong antiviral activity, inhibit viral replication very quickly, and are effective in a very large majority of patients. It is convenient to take just one pill per day and rarely has adverse effects. However, the effect of nucleoside analogues on “Tai San Yang” is very slow and unstable, and long-term medication is needed to maintain the effect. Even if the serum aminotransferase has been normalized and the virus is not detected, most of the patients will relapse after stopping the medication for a variable period of time. Nucleoside analogs can be resistant to each drug after a long period of treatment. To use these drugs well, the guidance of a doctor is necessary. Interferon treatment for 6 to 12 months is effective in clearing “major triplets”; serum transaminases are normal; and serum viruses are not detected. Interferon is effective by stimulating the patient’s immunity and is quite stable after discontinuation of the drug. Only about half of the patients can obtain three efficacy indicators in one course of treatment, and even if another course of treatment is used, only 70% to 80% of the efficacy is achieved. In addition, treatment with interferon has many adverse effects, and some patients with other diseases are not suitable for interferon. Do I need to consider treatment on my own? Each patient’s situation is different and their requirements are different, so it is not possible to say absolutely which drug is better. It is important to choose the most suitable one based on the characteristics of each drug according to your condition and other personal circumstances. Consider your age, future life pursuit, working conditions and economic conditions, past treatment and severity of hepatitis, etc. You can consult your doctor. A standardized doctor in a standardized hospital will analyze your condition and introduce the drugs to you objectively. To learn some correct knowledge about chronic hepatitis B: read some scientific information; it is better to have access to the Internet, I heard that “Liver and Guts” is the patient’s own website, which may have a common language with you. Among the patients I see, some have a good understanding of hepatitis B, have a more correct attitude towards the disease and treatment, and can tenaciously adhere to antiviral treatment; some patients are not financially well-off and can frankly discuss with their doctors to seek a suitable treatment plan for themselves. Chronic hepatitis B requires longer and sometimes more difficult treatment. Patients themselves must understand their disease in order not to be misled, to choose treatment according to their own conditions and desires, and to take initiative in the cooperation between doctors and patients. You should be in the leading position, the disease is your birth, the money to you to turn, the most reliable is your own. I myself am a doctor, of course, will not exclude doctors, because chronic hepatitis B is a relatively difficult to treat disease, the purpose of this is to fully mobilize the patient’s own initiative, communication between doctors and patients, close collaboration between doctors and patients. Which of the two classes of anti-hepatitis B drugs do you choose? Nucleoside analogs and interferons have different drug properties, different mechanisms of efficacy, and different therapeutic responses. First you have to make a choice, and it is not too late to take some time to figure out the differences before making a decision. If you are an older person, especially if you have diabetes or high blood pressure, it may be safer and more effective to choose a nucleoside analog. Both diabetes and hypertension medications are to be taken for a long time, and adding another nucleoside analog that is also to be taken for a long time may be acceptable to you. If you are a young person, it is not easy to accept long-term medication, especially for young men and women who have not yet had children, nucleosides have not been tested for embryonic teratogenicity, and you cannot fertilize or get pregnant while taking medication, so of course, interferon treatment that can be stopped for a short time is better. If you also have other diseases, such as autoimmune disease, hyper- or hypothyroidism, uncontrolled diabetes, uncontrolled hypertension, cardiac or renal insufficiency, psychosis, epilepsy, etc. These diseases are contraindications to interferon, but nucleoside analogs can be safely and effectively applied, and you rarely have drug conflicts with simultaneous treatment of these diseases. It is chronic hepatitis B, the disease is different should also have a choice. For example, in severe liver disease: jaundice that does not subside easily, ascites, and very low routine blood leukocytes or platelets, interferon cannot be used, but nucleoside analogs can be safely applied. How to choose for most patients who can use both interferon and nucleoside analogues? If interferon therapy is effective, it is certainly better to use interferon: it can be discontinued, the efficacy is more stable, the “major triplets” can be cleared more quickly, and there is even hope that the “minor triplets” can be cleared and cured within a few years after discontinuing the medication. However, the best results are not achieved by all patients who use interferon, while maintaining the efficacy with nucleoside analogues is something that most patients can achieve. Therefore, patients who want to be aggressive can choose interferon; those who want to be stable can choose nucleoside analogs. Can I get the benefits of both classes of drugs with combination therapy? Can a patient who is financially well-off and wants to combine two classes of drugs at the same time get the benefits of treatment aggressively and steadily? Interferon stimulates immune inflammation in order to clear the virus; while nucleoside analogs soon have normalized serum transaminases, suppressing inflammation in the liver, which is not conducive to the action of interferon. Clinical trials have repeatedly demonstrated that the combination of the two drugs does not improve the efficacy of treatment. Patients whose serum aminotransferases are still elevated after failure of interferon therapy can be switched to nucleoside analogs, and interferon has already improved the immune level to some extent, which will be more effective than patients who have not used interferon. In turn, if the nucleoside analogs are used first is a one-way street, because the treatment early serum transaminases can be normal, it is more difficult to switch to interferon; of course, you can also stop waiting for a relapse and then switch to interferon, but there is a serious risk of rebound, from the time of discontinuation to relapse can be 1, 2 months to more than 1 year, during which you have to be alert to the rebound, can be at ease? Thus, if the economy allows, you can try interferon first, and then switch to nucleoside analogues when it fails.