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Hay al menos 4 análogos de los nucleótidos/nucleósidos aprobados para el tratamiento de la hepatitis crónica por virus de la hepatitis B (HBC): lamivudina, adefovir dipivoxil, entecavir y telbivudina. La introducción de estos fármacos ha supuesto un cambio radical en el tratamiento de esta enfermedad. Las ventajas de estos fármacos son la administración oral, la excelente tolerancia y la eficacia en todos los tipos de HBC (enfermedad hepática compensada y descompensada). Las limitaciones son la necesidad de tratamientos prolongados que dificultan la adhesión y pueden ocasionar la selección de cepas del virus de la hepatitis B resistentes a los distintos fármacos. La tasa de resistencias es diferente para cada uno de los fármacos. Los análogos de nucleótidos, como el adefovir y el tenofovir, son útiles en pacientes con resistencia a análogos de nucleósidos, como lamivudina, entecavir y telbivudina, y viceversa. En casos de resistencia a uno de estos fármacos se aconseja el tratamiento combinado.
Palabras clave:
Hepatitis B
Lamivudina
Entecavir
Telbivudina
Tenofovir
Adefovir
At least 4 nucleos(t)ide analogs have been approved for the treatment of chronic hepatitis B: lamivudine, adefovir dipivoxil, entecavir, and telbivudine. The introduction of these drugs has radically changed the treatment of this disease. The advantages of these drugs are their oral administration, excellent tolerability and efficacy in all types of chronic hepatitis B (compensated and decompensated disease). The limitations are the need for prolonged treatments, which hampers adherence and can cause selection of HBV strains resistant to distinct drugs. The resistance rate differs for each of the drugs. Nucleotide analogs such as adefovir and tenofovir are useful in patients resistant to nucleoside analogs such as lamivudine, entecavir and telbivudine and vice versa. In cases of resistance to one of these drugs, combined treatment is advised.
Key words:
Hepatitis B
Lamivudine
Entecavir
Telbivudine
Tenofovir
Adefovir
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