First Hepatitis B Guidelines Update In The Last 5 Years Released By EASL

The first update since 2012 was presented by the European Association for the Study of the Liver (EASL) during a special session at its International Liver Congress last week in Amsterdam. For the first time revised clinical practice guidelines for the management of hepatitis B virus (HBV) infection include tenofovir alafenamide and present evidence about when and how to stop antiviral therapy.

The new guidelines were also published in the online edition of the Journal of Hepatology and will appear in the 2 August 2017 print edition.

The guidelines recommend treatment for everyone with HBV DNA above 2000 IU/ml, elevated ALT, and at least moderate liver necroinflammation or fibrosis. Also, people with cirrhosis should start treatment regardless of viral load (if detectable) or ALT level, while those with high HBV DNA (>200,000 IU/ml) and elevated ALT should start regardless of fibrosis stage.

The guidelines affirm that the treatment of choice is a potent nucleoside/nucleotide analog with a high barrier to resistance, including entecavir (Baraclude), tenofovir disoproxil fumarate (TDF or Viread) and tenofovir alafenamide (TAF or Vemlidy).

TAF has been added to recommended treatment due to its excellent efficacy and improved bone and kidney safety compared to TDF.

The other nucleoside analogs – adefovir (HepSera), telbivudine (Sebivo or Tyzeka) and lamivudine (Epivir) – are coming off the list of recommended options, as they are not as potent and are more prone to resistance.

Combination therapy with nucleoside/nucleotide analogs and pegylated interferon is not recommended, according to the guidelines.

For people with hepatitis delta (HDV) in addition to HBV, pegylated interferon for at least 48 weeks remains the recommended treatment.

HBsAg-positive patients should consider concurrent prophylaxis with nucleoside/nucleotide analogs when they start DAAs, and HBsAg-negative people should be monitored and tested for HBV reactivation if their ALT level rises.

The guidelines also recommend that HBsAg-positive and at-risk HBsAg-negative people undergoing chemotherapy or other immunosuppressive therapy should take preventive entecavir, TDF or TAF.

The updated recommendations are available online in advance http://www.journal-of-hepatology.eu/pb/assets/raw/Health%20Advance/journals/jhepat/JHEPAT6473onlineversion.pdf