Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B
This is an extract from the guidance and may be misleading if read alone. The complete guidance is available at guidance.nice.org.uk/ta96
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 (HBeAgpositive or HBeAgnegative), within its licensed indications.
1.2 Adefovir dipivoxil is recommended as an option for the treatment of adults with chronic hepatitis B (HBeAgpositive or HBeAgnegative) within its licensed indications if:
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treatment with interferon alfa or peginterferon alfa-2a has been unsuccessful, or
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a relapse occurs after successful initial treatment, or
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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:
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treatment with lamivudine has resulted in viral resistance, or
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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.