| Agent (Trade Name) | Route | Class | Dosage | Duration | Resistance | Side Effects | |
|---|---|---|---|---|---|---|---|
| Adults | Children | ||||||
| Interferons | |||||||
| Interferon α-2b (Intron A) | Subcutaneous | — | 5 × 106 IU daily or 10 × 106 IU 3 times weekly | 3 × 106 IU/m2, 3 times weekly, up to a maximum of 10 × 106 IU weekly* | HBeAg-positive: 16−24 weeks HBeAg-negative: 48 weeks | — | Influenza-like symptoms, fatigue, headache, malaise, emotional lability (anxiety, irritability) |
| Pegylated-interferon α-2a (Pegasys)† | Subcutaneous | — | 180 μg weekly | Not indicated in patients <18 years old | 48 weeks | — | |
| Nucleo(s)tide analogs | |||||||
| ETV (Baraclude)† | Oral | NUC | 0.5 mg daily in NUC-naïve patients‡ 1.0 mg daily in LVD-experienced patients‡ (≥16 years old) | Indicated for patients aged ≥2 years and weighing ≥10 kg Patients ≤30 kg: weight-based dosing of oral solution LVD-naïve: 3–9 mL daily LVD-experienced: 6–18 mL daily Patients >30 kg LVD-naïve: 10 mL (0.5 mg) solution or one 0.5-mg tablet daily LVD-experienced: 20 mL (1 mg) solution or one 1-mg tablet daily | ≥1 year HBeAg-positive: until HBeAg seroconversion* with maintained undetectable HBV DNA (plus ≥6–12 months' consolidation therapy) HBeAg-negative: until maintained undetectable HBV DNA (plus ≥6–12 months' consolidation therapy) | 1% at year 5 | Negligible |
| TDF (Viread)† | Oral | NUC | 300 mg daily‡ (patients ≥12 years) | Not indicated for patients <12 years old | None up to year 5 | Potential nephrotoxicity | |
| LdT (Tyzeka; Sebivo) | Oral | NUC | 600 mg daily‡ (patients ≥16 years) | Not indicated for patients <16 years old | 17% at year 2 | Negligible | |
| ADV (Hepsera) | Oral | NUC | 10 mg daily‡ (patients ≥12 years) | Not indicated for patients <12 years old | 29% at year 5 | Potential nephrotoxicity | |
| LVD (Epivir, Zeffix) | Oral | NUC | 100 mg daily‡ | Patients aged 2–17 years: weight-based dosing, oral solution or tablets; 3 mg/kg daily (maximum 100 mg daily)* | 24% at year 1 70% at year 5 | Negligible | |
Data compiled from Lok and McMahon,10 European Association for the Study of the Liver clinical practice guidelines,12 US prescribing information for Baraclude (Bristol-Myers Squibb, 2014); Viread (Gilead Biosciences, 2013); Tyzeka (Novartis, 2013); Hepsera (Gilead Biosciences, 2012); Epivir (ViiV Healthcare, 2013); Pegasys (Genentech/Roche, 2014); and Intron A (Merck, 2011).
↵* Use in pediatric patients approved in the United States but not in the European Union. Hepatitis B e antigen (HBeAg) loss and anti-HBe-positivity on 2 occasions 1–3 months apart.
↵† Recommended first-line agents.
↵‡ Dose adjustment is required in patients with impaired renal function (creatinine clearance <50 mL/min).
ADV, adefovir; ETV, entecavir; HBV, hepatitis B virus; LdT, telbivudine; LVD, lamivudine; NUC, nucleo(s)tide analog; TDF, tenofovir.