Cirrhosis - Treatment

Other agents under investigation include therapeutic vaccines and genetic therapies known as antisense oligonucleotides or monoclonal antibodies. InnoVac-C is one such vaccine undergoing Phase IIb clinical studies. In March 2004, Innogenetics reported 3-year histology data from an earlier InnoVac-C trial. After four courses of the vaccine, patients exhibited significant improvement in liver scarring, when compared to their baseline results. The HCV vaccine appeared to be well-tolerated. Even if successful, none of these agents would be available for some years.

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Of interest are studies using phlebotomy (which is simply drawing blood) to reduce iron levels. In one study, maintenance therapy with this procedure reduced liver inflammation and possible slowed progression of cirrhosis.

Treatments for Chronic Hepatitis B

An ounce of prevention is worth a pound of cure, and the phrase resoundingly holds true in the case of Hepatitis B. Today, a vaccine against HBV is available. It can prevent hepatitis B and therefore, it can also prevent liver cancer. The American Academy of Pediatrics and the Centers for Disease Control and Prevention currently recommend that all babies born in the United States receive a hepatitis B vaccine at birth.

Four drugs are currently approved in the United States for treatment of chronic hepatitis B: interferon-alfa-2b (Intron), adefovir (Hepsera), lamivudine (Epivir), and entecavir (Baraclude) These drugs block the replication of HBV in the body. A doctor will decide which drug to prescribe based on a patient?s age, disease severity, and other factors. Each drug has various advantages and disadvantages in terms of cost, efficacy, and likelihood of drug resistance. A combination of drugs may also be prescribed.

Interferon Alpha. For many years, interferon alpha-2b (Intron) was the standard drug for hepatitis B. The drug is usually taken by injection every day for 16 weeks. Unfortunately, the virus recurs in almost all cases, although this recurring mutation may be weaker than the original strain. Administering the drug for longer periods may produce sustained remission in more patients while still being safe. Interferon is also effective in eligible children, although long-term effects are unclear.

Lamivudine and Entecavir. These two drugs are classified as nucleoside analogs. Lamivudine (Epivir or 3TC) is an antiretroviral drug that is used to treat human immunodeficiency virus (HIV) as well as hepatitis B. Lamivudine has reduced viral count in over half of hepatitis B patients who have taken it as sole therapy for about a year. It is less expensive than interferon-alfa and has fewer side effects, but may not be as effective as interferon-alfa for long-term therapy. A major problem with lamivudine is the development of mutated viral strains that become resistant to the drug, particularly in areas where the virus is common. In 2005, the FDA approved entecavir (Baraclude) for treatment of adults with chronic hepatitis B. In clinical trials, entecavir was more effective than lamivudine for treating HBV. However, questions have been raised about the drug?s possible cancer risks. Ongoing studies are assessing this risk.