Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a

Summary

NICE has made the following recommendations about the use of adefovir dipivoxil and peginterferon alfa-2a to treat chronic hepatitis B. These recommendations do not apply to people who are also infected with hepatitis C or D, or HIV.

Peginterferon alfa-2a is recommended as a possible first treatment for adults with chronic hepatitis B, as long as it is suitable for the person and the exact type of hepatitis B they have.

Adefovir dipivoxil is recommended as a possible treatment for a person with chronic hepatitis B as long as it is suitable for the person and the exact type of hepatitis B they have. And if:

• treatment with peginterferon alfa-2a or another interferon called interferon alfa has not worked for that person, or
• treatment with an interferon worked at first, but the person has had a relapse, or
• the person can‘t take peginterferon alfa-2a or interferon alfa, or has had serious side effects from taking these medicines.

Adefovir dipivoxil should not normally be given before the person has had lamivudine treatment. It may be given – on its own or with lamivudine – when:

• the person’s hepatitis B virus has become resistant to lamivudine, or
• the virus is likely to become resistant to lamivudine quickly and the resistance could cause problems for the person, such as serious liver disease.

NICE has recommended that treatment with peginterferon alfa-2a or adefovir dipivoxil should be started only by a doctor who specialises in treating viral hepatitis. This specialist may then set up an arrangement so that the person’s GP can continue prescribing the medicine, with advice and guidance from the specialist (this is called a shared-care arrangement).

Documents

For healthcare professionals

• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Guidance (Word version)
• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Guidance
• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Quick reference guide

For patients, carers and the public

• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Information for the public

Background information

• Appendix A
• Review Decision - October 2007
• Appendix A - Matrix of consultees and commentators
• Review proposal - July 2007
• 2006/008 People with chronic hepatitis B to benefit from guidance on new drugs and treatments
• Assessment report: Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Slide set
• TA96 Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a: Analysis of cost impact