What are the AASLD recommendations for medications for the treatment of chronic hepatitis B (HBV) (Hep B)?

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

The following are medications approved for the treatment of chronic hepatitis B in pediatric and adult patients. Adjust all dosing in the setting of renal dysfunction.

Preferred drugs

Pegylated interferon (PEG-IFN)-alpha-2a (adults) or IFN-alpha-2b (children)

  • Adult dose: 180 μg weekly
  • Pediatric dose (age ≥1 year): 6 million IU/m 2 three times weekly
  • Pregnancy category: C
  • On-treatment monitoring: CBC count (monthly to every 3 months) and thyroid stimulating hormone level (every 3 months); evaluate for autoimmune, ischemic, neuropsychiatric, and infectious complications.

Entecavir

  • Adult dose: Daily 0.5 mg (lamivudine-naive persons) or 1.0 mg (those with lamivudine experience or decompensated cirrhosis)
  • Pediatric dose (age ≥2 years): Weight-based to 10-30 kg; for children weighing more than 30 kg, use 0.5 mg daily for lamivudine-naive children or 1.0 mg for those with lamivudine experience or decompensated cirrhosis
  • Pregnancy category: C
  • On-treatment monitoring: Obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment.

Tenofovir dipovoxil fumarate

  • Adult and pediatric (age ≥12 years) dose: 300 mg daily
  • Pregnancy category: B
  • On-treatment monitoring: Measure baseline creatinine clearance for those at risk for renal impairment, as well as at least annual levels of creatinine clearance, serum phosphate, urine glucose, and urine protein. Consider baseline and during-treatment bone density scans for those with a fracture history or at risk for osteopenia. Obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment.

Tenofovir alafenamide

  • Adult dose: 25 mg daily; no pediatric dosing
  • Pregnancy category: Insufficient human data
  • On-treatment monitoring: Obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment. Before initiation of, and during, therapy, measure serum creatinine, serum phosphorus, creatinine clearance, urine glucose, and urine protein levels in all patients as clinically appropriate.

Nonpreferred drugs

Adefovir

  • Adult and pediatric dose (age ≥12 years): 10 mg daily
  • Pregnancy category: C
  • On-treatment monitoring: Measure baseline creatinine clearance for those at risk for renal impairment, as well as at least annual levels of creatinine clearance, serum phosphate, urine glucose, and urine protein. Consider baseline and during-treatment bone density scans for those at risk for osteopenia or with a fracture history. Obtain lactic acid levels if lactic acidosis is a concern.

Lamivudine

  • Adult dose: 100mg daily
  • Pediatric dose (age ≥2 years): 3 mg/kg daily (maximum 100 mg)
  • Pregnancy category: C
  • On-treatment monitoring: Check amylase levels in symptomatic patients; obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment.

Telbivudine

  • Adult dose: 600 mg daily; no pediatric dosing
  • Pregnancy category: B
  • On-treatment monitoring: Check creatine kinase levels in, and perform a clinical evaluation of, symptomatic patients; obtain lactic acid levels if lactic acidosis is a concern.

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