Chronic hepatitis B (CHB) remains a major global healthcare challenge affecting approximately 350 million people, and is a leading cause of chronic liver disease, cirrhosis (liver scarring) and liver cancer. Despite the significant disease burden of CHB, it remains under-diagnosed with research suggesting that as few as 10% of those living with CHB are aware of their infection. Moreover, according to the latest WHO data, as few as 1 in 5 of those diagnosed were on treatment, highlighting the scale of the medical challenge ahead and the need for change in how we approach CHB. This blog highlights the limitations of current treatments and discusses novel approaches for the treatment and management of CHB.

 

Prevention is better than cure

A preventative vaccine (the hepatitis B vaccine) has been available for almost 40 years and is a key tool in the prevention of the morbidity and mortality associated with CHB. WHO recommends that all infants receive this vaccine within 24 hours after birth, followed by 2 or 3 further doses at least 4 weeks apart. This should offer protection for at least 20 years – possibly even for life. The virus is transmitted by exposure to infected blood and body fluids, so other preventative methods include the promotion of safer sex practices, as well as the implementation of blood safety strategies. To prevent transmission of hepatitis B virus from mother-to-child, antiviral prophylaxis is recommended in high risk pregnancies. Effectively utilising these approaches, fewer individuals will be affected by CHB in the future.

 

Source: Unsplash

 

The status quo

There is no ‘cure’ for CHB which is the reason why prevention is of utmost importance. The main goal of current treatment is to reduce the complications of CHB, such as cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). Hence, currently available antivirals are focused on suppressing the virus, normalising the liver enzymes and maintaining quality of life for the patient. Although pegylated interferon alfa-2a, a drug which modulates the immune system, is a recognised treatment strategy, it is rarely used in clinical practice today. Conversely, antiviral medications such as tenofovir and entecavir are widely used and are considered the first-line treatment by most treating clinicians. However, there are limitations with these current antiviral drugs, including adherence, cost, and potential side effects with long-term usage. Hence, it is critical that novel therapies are developed to offer finite treatment regimens and ‘functional cure’.

 

Promising new treatments

The goal of current therapies in clinical trials is to achieve “functional cure”, with improved clinical endpoints. The ideal treatment endpoint is considered Hepatitis B surface antigen (HBsAg) loss, which represents functional cure. Several new drugs are in development and many show promise in their ability to reduce HBsAg, potentially achieving a functional cure. These include small interfering RNA drugs (siRNAs) and antisense oligonucleotides (ASOs). Results to date with these novel therapies are encouraging, as they are both capable of significantly reducing the HBsAg level after finite periods of administration, raising hopes that these novel therapies will play a pivotal role in the HBV cure program. Thus, these developments may represent early steps on the path to replicate the success seen in the hepatitis C virus field.

 

Conclusion

CHB still poses a significant global healthcare concern, and advances in treatment are needed to improve patient outcomes. Some CHB patients, based on current guidance, do not require antiviral therapy as they have low levels of virus and persistently normal liver enzymes with no evidence of liver disease. Instead, these patients need to be monitored in the clinic to ensure they do not develop the complications of CHB at a later date. Identifying which CHB patients do not need antiviral therapy due to their low risk of disease progression or the development of HCC is critical to improve patient care. However, novel therapies are needed to achieve functional cure, which ultimately will transform the management of CHB by broadening treatment candidacy and preventing the complications of chronic infection, including liver cancer.

 

Source: Unsplash

 

 

 

In March of 2020, the WHO declared Covid-19 a pandemic and to date there are still no specific treatments and no licenced vaccines for coronavirus. However, preliminary data released this week from Pfizer suggest significant progress has now been made with highly encouraging results from a Phase 3 study. The interim results from the Pfizer study report that the vaccine is effective in preventing more than 90% of people from getting Covid. More data are awaited to confirm safety before emergency approval is sought and the vaccine is made available to the public.

While these data represent a major scientific breakthrough in tackling the Covid public health emergency, we will still have to overcome significant challenges before we have a number of safe and effective vaccines, which are available globally. Little detail is known at this juncture about immunogenicity; is it more (or less) effective in certain populations or age-groups and for how long is the vaccine effective?

In order to address these questions, amongst others, further vaccine trials are needed with the generation of more data to better understand how specific vaccines may be employed in the future. At present there are almost a dozen vaccines in late-stage clinical trials, which will ultimately lead to the selection of the best vaccines based on the efficacy and safety.

Hello and a very warm welcome to my blog.

Delivering the highest quality medical care is at the heart of my clinical practice and also drives my academic research in liver disease. Since my appointment as a Senior Lecturer & Consultant at Barts and The London School of Medicine and Dentistry in 2009, I have built a world leading translational research portfolio, seamlessly linking my clinical work with research excellence. At the centre of this work, has been my research into chronic hepatitis B (CHB).  

 

My seminal work on the management of CHB in young people is changing clinical practice. At a time of remarkable progress in the field of viral hepatitis; the licensing of curative therapies for chronic hepatitis C virus (HCV), the development of novel therapies in the pursuit of functional cure in CHB and much needed new therapies entering clinical trials for hepatitis Delta virus (HDV); there is a pressing need to convey these developments to patients to ensure a wider audience understand the progress in the field and are aware of the potential impact these advances will have on the management of their disease. I hope to use this blog to inform people and where possible, provide practical advice and insight into the diagnosis and treatment of CHB as well as other liver diseases. 

 

Over the last 10 years, I have been fortunate enough to contribute to the quest to achieve functional cure and have built outstanding research collaborations with world-leading researchers in the field. I believe that progress towards functional cure in CHB will only be achieved through a coordinated and concerted global research effort to address the key unanswered questions in the field. My research efforts draw on and partner with the unique expertise of collaborators from Singapore, China, America, Italy, Germany and France to name but a few, highlighting my commitment to a global effort to improve patient care.  

I put the patient at the centre of everything I do, from treatment and management decisions, to teaching, education and research. I passionately believe that better patient understanding and disease awareness are critical to early diagnosis, improved care, superior treatment outcomes and the overall improvement in the wellbeing of patients with liver disease.  

 

Many people are nervous about contacting a Doctor or anxious about their symptoms or even diagnosis. I take great pride in my work and strive to deliver the highest quality of care to every patient I see. It’s important to me that you feel heard, respected and treated with the utmost care – this is my guarantee to you as a patient and forms the basis of my quest to deliver tailored care to meet the needs of every patient I see. 

 

You can find out more about my medical background on the ‘About’ page. 

 

If you’re interested in reading some of my published work, you can find a list of published articles here.

 

Thanks again for visiting my website and please feel free to get in touch if you have any feedback or comments. 

 

With best wishes,

Dr Patrick Kennedy