There are many kinds of anti-HBV drugs for hepatitis B that are widely used in the clinic in China. Among them, oral anti-HBV drugs for hepatitis B, entecavir (such as Boludin and Renzo) have been unanimously recommended by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of Liver Diseases (EASL), the Asia-Pacific Society for the Study of the Liver (APASL) and the Chinese guidelines for the prevention and treatment of chronic hepatitis B as first-line drugs for the treatment of active chronic hepatitis B. Entecavir tablets were launched globally simultaneously in November 2005 and have accumulated a large amount of rich clinical application experience since then. Its potent anti-HBV ability and extremely low incidence of drug resistance have been unanimously recognized by domestic and international hepatologists during long-term practice. Long-term clinical data of entecavir show that 94% of patients with chronic hepatitis B “major triple-positive” can achieve undetectable HBV DNA among those who have taken entecavir for more than 5 years. And the incidence of drug resistance is only 1.2%. The author started using entecavir tablets as one of the first-line potent and low resistance drugs for the treatment of hepatitis B. The author started using entecavir (Boludin) in the clinic at the beginning of the market in 2005, and the cumulative number of patients over the past 9 years is relatively large, and the majority of them have achieved very satisfactory results, and I have also had a profound experience with the drug. However, in my daily work, I still found that there were individual patients from primary care hospitals who had less than satisfactory results after taking entecavir. After careful questioning, most of these patients would say that they would take one tablet every day as prescribed by the doctor, but if I continued to ask in detail, “When do you take the medicine every day? Did you fast for 2 hours before and after taking the medication?” At this point a variety of responses emerge and the answer to the poor effectiveness of entecavir is revealed. The reason why many patients have poor results is that they have not mastered the specific method of taking entecavir on an empty stomach for at least 2 hours before or after a meal, and some doctors, especially non-hepatologists, have overlooked the importance of this issue in their clinical work. Please note that the “dosage” section of the instructions for entecavir tablets (which are included in every box of the drug) states that the product should be taken on an empty stomach (at least 2 hours before or after a meal). When you see this, many patients may wonder, “Why should I take entecavir on an empty stomach?” The answer is already stated in the “Pharmacokinetics” section of the instructions, which states that oral administration of 0.5 mg entecavir with a standard high-fat or low-fat meal results in a slight delay in drug absorption (from 0.75 hours to 1.0-1.5 hours), a decrease in peak blood concentration (C max) 44 ~46% and the area under the curve (AUC) is reduced by 18-20%. Therefore, entecavir should be taken on an empty stomach (at least 2 hours before or after a meal). In other words, only when the drug is taken on an empty stomach as required can its efficacy be maximized. From the clinical summary, many patients’ mistakes in taking medication are generally the following: 1. The concept of fasting is not clear: For example, some patients think that as long as they do not eat with other foods are fasting. But he ignores that eating before and after taking medication can also have a great impact on drug absorption. The concept of at least two hours before or after a meal is not clear: For example, some patients think that they are fasting when they wake up, so they take one tablet of entecavir and go on to eat breakfast. Indeed, he was fasting when he got up, but the time between his medication and breakfast was much less than 2 hours! 3, for self-management is not rigorous: some patients are fully understand the doctor’s explanation of his things, usually is also in accordance with the instructions of the medication. However, when sometimes going out to socialize or hungry at night, they can forget to take the medicine or take the medicine after a snack. In the end, it still leads to ineffective medication taking. 4, doctors in the medication before the explanation work is not in place: failed to repeatedly emphasize the importance of 2 hours before and after meals to take drugs on an empty stomach, only to prescribe drugs to patients to take or simply say “take drugs on an empty stomach” on the line. My advice to patients is to keep the entecavir box on the bedside table and take one tablet of entecavir before going to bed at night after freshening up. The longer the interval, the better to ensure a pre-dose fasting time of 2 hours or more. Patients who fall asleep soon after taking the drug will generally not get up to eat within 2 hours, and will sleep until morning when they have fasted for at least 5 hours. (Of course, during this fasting period, you can drink a small amount of water). This can ensure that the medication is taken on an empty stomach (at least 2 hours before or after a meal) and can avoid forgetting to take the medication, just like turning off the light before going to bed, which is a must-do before going to bed after getting used to it. In order to avoid these problems, I will communicate and explain as much as possible before prescribing entecavir, so as to greatly improve the patient’s compliance (patient’s compliance is the most basic guarantee of good results, otherwise the best treatment plan is ineffective even if the patient does not implement it well). Generally, I will first carefully explain how to take the medication correctly, tell the patient not to stop taking the medication at will, the need to take the medication on an empty stomach and the need for close follow-up, and then ask the patient to repeat it to make sure he really understands it before I show the dial of my watch and point to the time scale to discuss with him the interval of taking the medication. Entecavir is a very effective anti-HBV drug, but because of the special nature of the drug, during the period of taking the drug doctors and patients should pay attention to the correct method of taking the drug, the correct use of drugs, better control of the disease, I believe that we will get satisfactory results, to improve the quality of life, as far as possible to extend the life of the treatment compliance.
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