Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop

Abstract

Clinical practice guidelines are important for guiding the management of specific diseases by medical practitioners, trainees, and nurses. In some cases, the guidelines are utilized as a reference for health policymakers in controlling diseases with a large public impact. With this in mind, practice guidelines for the management of chronic hepatitis B (CHB) have been developed in the United States, Europe, and Asian-Pacific regions to suggest the best-fit recommendations for each social and medical circumstance. Recently, the Korean Association for the Study of the Liver published a revised version of its clinical practice guidelines for the management of CHB. The guidelines included updated information based on newly available antiviral agents, the most recent opinion on the initiation and cessation of treatment, and updates for the management of drug resistance, partial virological response, and side effects. Additionally, CHB management in specific situations was comprehensively revised. This review compares the similarities and differences among the various practice guidelines to identify unmet needs and improve future recommendations.

External validation of CAGE‐B and SAGE‐B scores for Asian chronic hepatitis B patients with well‐controlled viremia by antivirals

“…Primarily on the strength of antiviral treatment (AVT) using oral nucleos(t)ide analogues (NUCs) suppressing viral replication, both virological and biochemical remission could be easily achieved in most of treated patients, where necro‐inflammation and resultant fibrosis could be significantly improved 6–8 . Nevertheless, AVT decreases but does not eliminate the risk of HCC development completely, primarily owing to complex direct and indirect mechanisms of hepato‐carcinogenesis 9–13 …”

Secondary prevention of hepatitis B virus‐related hepatocellular carcinoma with current antiviral therapies

“…These antiviral treatments have been proved to effectively decrease the development of HCC by randomized trials. 13,14 Most of current practice guidelines for CHB have similar indications of antiviral treatment, [15][16][17][18][19] based on elevated serum levels of alanine aminotransferase (ALT) and HBV DNA in CHB patients without cirrhosis. Although the European clinical practice guidelines recommend that patients with HBeAg-positive CHB may be treated if they are older than 30 years and have high HBV DNA levels despite persistently normal ALT, the evidence level is very low (Evidence level III, grade of recommendation 2).…”

The Prognostic Role of On-Treatment Liver Stiffness for Hepatocellular Carcinoma Development in Patients with Chronic Hepatitis B

“…Furthermore, patients also underwent ultrasonography and assays for measuring serum alpha-fetoprotein levels every 6 months to screen for HCC and portal hypertension-related complications. 4,16,28 Liver cirrhosis based on ultrasonographical findings was defined when at least one of the following criteria was fulfilled; the presence of an irregular, nodular liver surface, highly coarse liver echotexture, a blunt liver edge, shrunken liver parenchyma, disturbed vascular architecture, or other findings suggestive of portal hypertension including splenomegaly (size >12 cm) and/or portosystemic collaterals. [29][30][31][32] The primary endpoint of this study was HCC development.…”

“…The overall prognosis of chronic hepatitis B virus (HBV) infection has improved primarily owing to long-term antiviral treatment (AVT) with potent oral nucleos(t) ide analogs (NUCs), such as entecavir (ETV) or tenofovir disoproxil fumarate (TDF), to prevent liver-disease progression and achieve to virological and biochemical remission. [1][2][3][4] However, as hepato-carcinogenesis is very complex based upon both host and viral factors, [5][6][7][8][9][10] it is difficult to eradicate, and some patients show HCC development, which remains a major public health problem in HBV-endemic areas. 11 Therefore, in addition to AVT, early detection of HCC by periodic surveillance is of paramount importance to allow timely interventions with a curative intent.…”