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 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 drug can cause deterioration of the disease. First of all, the advantages of this drug (in the absence of TDF listed): 1, the strongest antiviral effect is currently the strongest antiviral ability of an antiviral drug, the ability to inhibit the virus is higher than Adefovir nearly 10 times more, so suitable for all the people with different viral loads, most patients can quickly turn the virus within 6 months, so the ability to control the disease is the strongest. 2, the lowest risk of drug resistance Drug resistance (also known as viral mutation) is a common disadvantage of all oral antivirals, including entecavir. However, entecavir is currently the least resistant of all antiviral drugs and the least prone to viral mutation, with a very encouraging 6-year risk of resistance of only 1.2 percent. 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 the 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 those who are older, have comorbidities, have lower immunity, and have cirrhotic ascites. 3, low side effects Entecavir side effects are low, gastrointestinal reactions are very low, and can be tolerated for a long time. Some years ago it was thought that entecavir could lead to tumorigenesis, but so far there is no evidence of such an effect, and of course it is contraindicated in pregnant women. 4.Wide range of population Suitable for all adult population, those who do not need fertility and long-term treatment, especially those above S2, with normal liver function and good economic condition. The effect of controlling the progress of cirrhosis and inhibiting the occurrence of liver cancer are good. Next, the disadvantages: 1. expensive Whether domestic or imported, they are more 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 within their means. 2, the inconvenience of taking required 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 be turned into an advantage, which allows patients to develop good habits and quit smoking and drinking, which is so needed for patients with liver disease. 3, 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 negative viral regression (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 to a larger group of people after taking the drug is prone to ALT elevation, probably due to the strong antiviral ability of the drug, but generally belong to a 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 for 3 months, it is recommended to change the drug; if the response is poor for 1 year, it is recommended to double the drug or 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 not stop taking it, including people with low immunity and comorbidities 4, people who are resistant to adefovir side effects of entecavir In fact, the instructions of entecavir have been detailed, it is recommended that patients must read carefully before using entecavir with this drug. The actual side effects of entecavir have been explained in detail in the manual. 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 liver 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 in animal experiments have the risk of fetal malformation, generally not allowed to use in pregnant women; of course, the male side can use after pregnancy, there is no international expert consensus, but there is a point, certainly less than the female side impact, of course, or safety is the first. The combination therapy of entecavir: 1, entecavir combined with interferon therapy: Initially combined with 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. However, how to sequential combination, is still the direction of domestic and foreign research, but also did not form a 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.