Current status of nucleoside antivirals in chronic hepatitis B

Chronic hepatitis B is a serious disease both worldwide and in the United States. There are two types of drugs available to treat chronic hepatitis B virus (HBV) infection: interferons that boost the immune system, and antiviral or nucleoside analogues that are designed to interfere with HBV DNA to prevent its replication. This review focuses on nucleoside antivirals, namely lamivudine, entecavir and telbivudine, which are widely prescribed for patients with the disease, particularly lamivudine. Additionally, current Food and Drug Administration-approved nucleoside antivirals for hepatitis B will be briefly highlighted. Comparisons are performed based on previous clinical trials from primary sources. Treatments with entecavir and telbivudine are compared with lamivudine treatment in regard to pharmacotherapy, resistance and cost-effectiveness. Outcomes varied depending on each trial, but the main findings were more favorable for entecavir and telbivudine treatments than for lamivudine treatment. It was concluded that entecavir treatment is associated with better outcomes than lamivudine in the three aspects studied. Similarly, telbivudine showed more improvements than lamivudine in all three areas. Concomitant pharmacotherapy, especially in lamivudine-refractory patients, demonstrated significant improvement in the management of chronic hepatitis B. Furthermore, the availability of hepatitis B vaccines should enable us to prevent the occurrence of the disease.