Which drug is the best choice for chronic hepatitis B? In the past there were no specific drugs against hepatitis B virus, only liver protection and enzyme-lowering drugs to treat chronic hepatitis B. Of course, many patients had very bad consequences. In the last decade or so there are two types of antiviral drugs, curing many patients, but still very unsatisfactory, there are some problems, the end of this article has two users of the question. No one would question the need for penicillin when you have pneumonia, but why are there different opinions on the use of interferon and nucleoside analogues for chronic hepatitis B? Because the antiviral treatment of chronic hepatitis B is not simple and easy, and it requires more accurate selection and standardized medication. Are you still confused about this? What are the anti-hepatitis B virus drugs? 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 kinds of commodities are Pyroxin and Pellegrin); there are 4 kinds of nucleoside analogues: lamivudine (trade name Herceptin), adefovir (Heveley, Daidin, Namezheng), entecavir (Boludin) and telbivudine (Sulbivir). China’s pharmaceutical market is in the process of consolidation, some drugs have not yet been approved for advertising; some drugs have been approved as liver protection drugs, but not approved as antiviral drugs; hepatitis B vaccine is used for prevention, 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, can quickly inhibit viral replication, and are effective in the vast 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, the majority of 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, you must have the guidance of a doctor. Interferon is effective for 6-12 months, and the indicators of efficacy are clearance of “major triplets”; normal serum transaminases; and no detectable serum viruses. Interferon works by stimulating the patient’s immune system 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%-80% of the patients can obtain satisfactory efficacy. In addition, treatment with interferon has a number of adverse effects. Do I need to consider treatment on my own? Each patient’s situation and requirements are different, and it is not possible to say absolutely which drug is better. You need to choose the more suitable one from the characteristics of each drug according to your condition and other personal circumstances. It is necessary to consider one’s age, future life pursuits, working conditions and economic conditions, past treatment and the degree of hepatitis, etc. You can consult with your doctor. A standardized doctor in a standardized hospital will analyze your condition and introduce the medication objectively. To learn some correct knowledge about chronic hepatitis B: read some scientific information; it is better to get on the Internet, I heard that “Liver and Guts” is the patient’s own webma, which may have a common language with you. Among the patients I see, there are some who have considerable knowledge 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 yourself should be in the leading position. You are the one who has the disease, you spend the money, and you are the one who can be relied on most. I myself am a doctor, of course, will not exclude doctors, because chronic hepatitis B is a relatively difficult 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. First, 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 about this, 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 less easy to accept long-term medication, especially young men and women who have not yet had children, nucleoside analogues have not been tested for embryonic teratogenicity, and you cannot fertilize or become pregnant while taking medication, but of course interferon treatment that can be stopped in a short period of 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 with nucleoside analogs they are safe and effective, and you rarely have drug conflicts when treating these diseases at the same time. It is chronic hepatitis B, the disease is different should also be selected. 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. So how do you choose for most patients for whom both interferon and nucleoside analogues are available? If interferon therapy can be effective, it is certainly better to use interferon: you can stop the drug, the efficacy is more stable, you can clear the “big three” sooner, and there is even the hope of clearing the “small three” within a few years after stopping the drug and getting cured. The best results are not achieved by all patients who use interferon; however, the majority of patients are able to maintain the efficacy with nucleoside analogues. Therefore, patients who want to be aggressive can choose interferon, while those who want to be stable can choose nucleoside analogs.