Novel developments of hepatitis B: treatment goals, agents and monitoring tools

Expert Rev Clin Pharmacol. 2019 Feb;12(2):109-120. doi: 10.1080/17512433.2019.1567327. Epub 2019 Jan 21.

Abstract

Chronic hepatitis B (CHB) infection causes considerable morbidity and mortality and hence should be a target for global elimination. In recent years, advances have been made in understanding the disease pathophysiology and the relationship to clinical outcome. Novel treatment targets are actively being sought in the hope of improving the treatment outlook. Areas covered: We discussed the cascade of cure of CHB with respect to the degree of persistence of viral genome and proteins. Several novel antiviral agents either targeting the virus or the host are in different clinical phases of development. Serum hepatitis B core-related antigen and HBV RNA are novel markers, which might have a role in the prediction of specific clinical outcomes such as development of hepatocellular carcinoma or virological relapse after cessation of antiviral therapy. These markers may also be used to monitor treatment response in the drug trials. Expert commentary: Global elimination of CHB is challenged by extremely low awareness of illness and poor access to care. CHB and its related complications can be reduced by birth dose vaccine, antiviral therapy, and alleviated by complication screening. Treatment options for CHB will expand in the next decade and early functional cure is not an impractical goal.

Keywords: Antiviral therapy; HBV RNA; RNA interfering gene silencer; cirrhosis; core protein allosteric modulator; covalently closed circular DNA; cure; genome editing; global elimination; hepatitis B core-related antigen; hepatitis B virus; hepatocellular carcinoma; immunomodulator; integrated DNA; prevention; programmed cell death protein 1; therapeutic vaccine; vaccination; viral entry inhibitor.

Publication types

  • Review

MeSH terms

  • Animals
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Biomarkers / blood
  • Health Services Accessibility
  • Hepatitis B Core Antigens / blood
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / physiopathology
  • Hepatitis B, Chronic / virology
  • Humans
  • Molecular Targeted Therapy*
  • RNA, Viral / blood
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Biomarkers
  • Hepatitis B Core Antigens
  • RNA, Viral