What are the anti-hepatitis B virus drugs? The only approved anti-hepatitis B virus drugs are 2 types of interferon (regular interferon and polyethylene glycol interferon) and 4 nucleoside analogs. Generic interferon is available in a variety of domestic products (Seroquel, Andafen, Amphotericin, etc.); polyethylene glycol interferon is a long-acting agent and is available in 2 commercial products (Paroxetine and Pelargonic). Nucleoside analogs include lamivudine (Heptin), adefovir (Herve Leigh, Daidin, Mingzheng, etc.), entecavir (Borudin, Velicin, Runzhong, etc.), and telbivudine (Sobivudine). Tenofovir, a nucleoside analog, has been used in the clinical application of anti-hepatitis B virus treatment in foreign countries, and is expected to be listed and applied in the clinical application in China in the near future. China’s pharmaceutical market is in the process of rectification, some drugs have not yet been approved to advertise; some drugs have been approved as hepatoprotective drugs, but not approved as antiviral drugs. Standardized hospitals and standardized doctors can only use standardized drugs. What is the difference between interferon and oral antiviral drugs Interferon injections and oral antiviral drugs are two completely different types of anti-hepatitis B virus drugs, oral antiviral drugs have a direct anti-hepatitis B virus effect, interferon also has an antiviral effect, but it is mainly immune-modulating agents. The nature is different, the mechanism of efficacy is different, the reaction is different, and each has its own advantages and disadvantages. What are the characteristics of oral antiviral drugs? Oral antiviral drugs are very active, inhibit viral replication very quickly, and are effective in the vast majority of patients. After treatment, most patients with chronic hepatitis B can normalize their serum aminotransferases in 3 months or so, and it takes more than 1 year for patients with very high viral levels, and only a few months for those with low viral levels; however, the effect on “triple positive” is very slow, and only 12%-22% of them turn into “triple positive” every year. Only 12% to 22% turn into “small triple positive” every year. Oral antiviral drugs need to be taken for a long time, there is no definite course of treatment, and only maintenance treatment can have a maintenance effect. Can not be stopped at will, even if the serum aminotransferase has been normalized, the virus can not be detected, after stopping the medication after an indeterminate period of time, the majority of patients will relapse. Seriously, 10% to 30% of them will have an acute exacerbation of the disease, especially in the original heavy and cirrhotic patients, the consequences may be disastrous. After a long period of treatment with oral antiviral drugs, resistance to each drug may occur, and Herceptin is the drug to which more resistance occurs more quickly, while entecavir and tenofovir are the drugs to which less resistance occurs. Thus, although oral antiviral drugs are simple to take and have few adverse effects, they must be regulated under the guidance of a doctor. What are the characteristics of interferon? Interferon 6-12 months of treatment, the efficacy of the indicator is to clear the “triple positive”, that is, HBeAg turn negative, HBeAb turn positive; serum aminotransferases are normal; the virus is not detected. Interferon through the stimulation of the patient’s immunity to achieve efficacy, the results are more stable after stopping the drug, after a few years and even “small triple positive” can be cleared. Because interferon has to gain efficacy through immune stimulation, each person’s response is very different. Some patients obtain three efficacy indicators in 2 to 4 months, some 2 to 3 years before it is possible, and most patients need 8 to 10 months or even longer. Some patients remain ineffective even after longer periods of treatment. Treatment with interferon has a number of adverse reactions, because it has been used for many years, as long as the close cooperation with the doctor, under the doctor’s close observation, the treatment is safe, this adverse reaction is also basically controllable. Some patients are not suitable for interferon, such as psychosis, uncontrolled epilepsy, autoimmune diseases, uncontrolled diabetes mellitus, uncontrolled moderate or severe hypertension, cardiac insufficiency, alcoholism, drug abuse, jaundice, and decompensated liver disease. What are the immediate goals of antiviral therapy? For interferon treatment of chronic hepatitis B with “major triple positive”, the immediate efficacy should be: “major triple positive” to “minor triple positive”, HBV DNA undetectable and normal liver function. For chronic hepatitis B with “minor triple positive”, HBV DNA is undetectable and liver function is normal. Generally speaking, patients with “triple positive” need to be treated for 6 to 12 months, and some of them need to extend the course of treatment; patients with “triple positive” are more prone to relapse, and should be treated for at least 12 months. Oral antiviral drugs can quickly achieve HBV DNA undetectable and normal liver function, in the long-term treatment need to be changed in time before the occurrence of drug resistance, as long as the maintenance of treatment, can maintain the therapeutic effect, but does not mean that oral antiviral drugs need to be lifelong, in the irregular long time after the treatment, you can be cautious under the observation of the doctor to stop the drug. There is now more support for preferring entecavir or tenofovir antiviral in first-treatment patients to minimize the possible occurrence of drug resistance. What are the advantages and disadvantages of each of the two antiviral drugs? Oral antiviral medications have a direct effect against the hepatitis B virus, inhibit viral replication more strongly, control symptoms more quickly, and are effective in a very high percentage of patients. Interferon also has antiviral effect, but it is mainly an immunomodulator, and each patient’s response to stimulate the immune system is different, so it is not effective for every patient. Chronic hepatitis B is not a disease that can be treated in the short term. After the “major triple positive” is cleared, the “minor triple positive” will remain for a longer period of time and cannot be considered cured. Oral antiviral drugs have no immune effect, so they cannot be stopped within a few years, and most of them will recur after stopping; interferon therapy has stimulated sufficient immune function in patients, and the clearance rate of “triple positive” is higher, and it can continue to inhibit viral replication and make the inflammation last for a long time after stopping. After switching to “small triple positive”, stopping the drug can continue to inhibit viral replication, so that the inflammation continues to ease, fewer relapses after stopping the drug, and the antiviral effect is more stable. Patients with effective treatment may be cured of “small triple positive” within a few years. However, before treatment, we must have a clearer understanding of the possible side effects caused by interferon. What are the advantages of long-acting interferon? Long-acting polyethylene glycol formulations are second-generation, improved interferons that share the same characteristics as interferon. Regular interferon is injected three times a week and only maintains therapeutic levels for about ten hours at a time; long-acting interferon is injected once a week and maintains a constant concentration of the drug in the blood. Long-acting interferon significantly improves the efficiency of treatment; it may also be effective in hard-to-treat patients with very high levels of virus; some patients who have failed regular interferon therapy have gained efficacy after switching to long-acting interferon. The relapse rate of long-acting interferon is very low, which makes it a better choice for patients who are prone to relapse. Long-acting interferon has increased efficacy due to prolonged blood concentration, but also increased adverse effects due to prolonged blood concentration, which are of the same nature as those of regular interferon. Some patients are not suitable for interferon, such as psychosis, uncontrolled epilepsy, autoimmune diseases, uncontrolled diabetes mellitus, uncontrolled moderate or severe hypertension, cardiac insufficiency, alcoholism, drug abuse, jaundice, and decompensated liver disease. Can long-acting interferon cure chronic hepatitis B? Long-acting interferon treatment course of 1 year, more than half of the patients can get stable treatment effect, namely, “big triple” to “small triple”; serum aminotransferases are normal; the virus can not be detected. In these effective patients, nearly 10% at the end of treatment, even represents the “small triple positive” hepatitis B surface antigen (HBsAg) can be cleared, higher than the clearance rate of ordinary interferon. When “minor triple positive” is cleared, chronic hepatitis B is said to be cured. However, the cure rate at the end of treatment is still low, less than 5% of all patients treated with long-acting interferon. Although patients with “minor triple positive” have controlled significant viral replication, the hepatitis B virus is still present in the hepatocytes, and patients who have been treated effectively with interferon already have strong immune function and can continue to suppress viral replication. In this way, the newborn hepatocytes will not be infected, and the virus-infected hepatocytes will be metabolized by aging, and most of the patients will be able to get rid of “small triple Yang” after a long or short period of time. Ordinary interferon treatment of chronic hepatitis B for 20 years (after 1992 began to be applied to the clinic), the end of the treatment after long-term observation of 5 years, nearly half of the clearance of “small triple Yang”; long-acting interferon (Pyroxin) than the role of ordinary interferon, long-term efficacy of course, will be better. Therefore, we can not take the cure of chronic hepatitis B as a near-term goal, but can be a reliable hope.