Perrillo, RP and Gish, RG and Peters, M and Keeffe, EB and Alberti, A and Buti, M and Cooksley, WGE and Fried, MW and Hadziyannis, SJ and Liaw, YF and Naoumov, NV and Schiff, ER and Thio, CL and Tsai, N and Schalm, S (2006) Chronic hepatitis B: A critical appraisal of current approaches to therapy. CLIN GASTROENTEROL H , 4 (2) 233 - 248. 10.1053/s1542-3565(05)00983-3.
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Background & Aims: Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature. Methods: A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups. Results: With the exception of 2 statements, the experts' responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas. Conclusions: Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.
|Title:||Chronic hepatitis B: A critical appraisal of current approaches to therapy|
|Keywords:||ADEFOVIR DIPIVOXIL ADV, SERUM HBV-DNA, POST-LIVER TRANSPLANTATION, ALPHA-INTERFERON TREATMENT, CHRONIC VIRAL-HEPATITIS, E-ANTIGEN, VIRUS-INFECTION, LAMIVUDINE TREATMENT, COMBINATION THERAPY, PHASE-III|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)|
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