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

1. Guidance

This guidance does not apply to people with chronic hepatitis B known to be co-infected with hepatitis C, hepatitis D or HIV.

1.1. Peginterferon alfa-2a is recommended as an option for the initial treatment of adults with chronic hepatitis B (HBeAg-positive or HBeAg-negative), within its licensed indications.

1.2. Adefovir dipivoxil is recommended as an option for the treatment of adults with chronic hepatitis B (HBeAg-positive or HBeAg-negative) within its licensed indications if:

• treatment with interferon alfa or peginterferon alfa-2a has been unsuccessful, or
• a relapse occurs after successful initial treatment, or
• treatment with interferon alfa or peginterferon alfa-2a is poorly tolerated or contraindicated.

1.3. Adefovir dipivoxil should not normally be given before treatment with lamivudine. It may be used either alone or in combination with lamivudine when:

• treatment with lamivudine has resulted in viral resistance, or
• lamivudine resistance is likely to occur rapidly (for example, in the presence of highly replicative hepatitis B disease), and development of lamivudine resistance is likely to have an adverse outcome (for example, if a flare of the infection is likely to precipitate decompensated liver disease).

1.4. Drug treatment with peginterferon alfa-2a or adefovir dipivoxil should be initiated only by an appropriately qualified healthcare professional with expertise in the management of viral hepatitis. Continuation of therapy under shared-care arrangements with a general practitioner is appropriate.