Hepatitis B feared, but is curable
Hepatitis B feared, but is curable
The World Health Organization estimates that 2 billion people are
infected by Hepatitis B virus (HBV) and of that amount 400
million chronically infected, which left untreated could develop
into cirrhosis or liver cancer.
George K.K. Lau from the Hong Kong University said that 75
percent of the people with HBV were from the Asia-Pacific region.
Indonesia ranks third after China and India. Hepatitis B
causes extensive liver damage and is often transmitted through
maternal-infant vertical transmission.
"It is very important to disseminate the information about
this disease because it slowly transgresses, so many people will
not able to detect it until it reaches an advanced stage. At
around 40 to 60 years, if left untreated, people will already
have liver cancer or cirrhosis," he said.
Indonesia with an estimated 11.6 million people with HVB, he
said, was only one tenth of the number that China dealt with,
which saw 120 million people.
But Indonesia has the same problem as other countries in Asia
where many patients are left untreated, he added. It is
necessary to reduce the risk of getting liver cancer if not
Indonesia, for example, faces the death of 50,000 people every
year from this disease," Lau said.
Stemming from this concern, Lau, who is a physician at the
Queen Mary Hospital in Hong Kong, conducted a study on the
treatment of Hepatitis B along with a number of specialists from
throughout the world. His study was published in the June edition
of The New England Journal of Medicine.
The study itself was initiated in 1998 and was completed last
year, involving 841 patients.
"Treatments for chronic hepatitis B are suboptimal. In the
search for improved therapies, we compared the efficacy and
safety of pegylated interferon alfa or Pegasys plus lamivudine,
pegylated interferon alfa without lamivudine and lamivudine alone
for the treatment of hepatitis B e antigen (HBeAg) -- positive
chronic hepatitis B.
Peginterferon alfa-2a or Pegasys works in two ways:
stimulating the immune system and inhibiting viral replication.
It is taken once a week for 48 weeks.
Lamivudine is an oral medicine that is taken once a day to
treat chronic hepatitis B. The drug belongs to a class of
medicine called "nucleoside analogs." Patients typically have to
keep taking this medicine indefinitely. In addition, long-term
treatment may also result in drug resistance and as a consequence
there will be progression of liver disease and liver damage.
Current consensus guidelines from Asia, Europe and the United
States recommend lamivudine, adevoir or conventional interferon
alfa for the treatment of chronic hepatitis B. Pegasys however,
had been widely used in the treatment of hepatitis C.
During the 48-week observation period, many patients tolerated
Pegasys very well, Lau said, adding that there were expected side
effects like fatigue, headaches, myalgia and pyrexia.
"The number of those who got minor side effects is
insignificant," he said.
What is the clinical implication of Lau's study then?
It was found that peginterferon alfa-2a alone or in
combination with lamivudine resulted in higher rates of sustained
HBeAg HBsAg, virologic and biochemical response among patients
with HBeAg-positive chronic hepatitis B than did lamivudine
alone.
One example, he said, was a 44-year-old patient. This
unidentified patient was diagnosed with hepatitis B after his
brother died of liver cancer. Amazingly, Lau said, this man could
achieve Seroconversion without a dose reduction in his 44-week
long treatment using this new combination of Pegasys.
Manufactured by Roche, Pegasys was already approved by
Indonesian's Food and Drug Agency (BPOM) last month, nine months
earlier than expected.
In terms of cost, Lau said it would save much of the expenses
because of the finite treatment duration. -- Emmy Fitri