Adverse effects of oral antiviral therapy in chronic hepatitis B

Table 1 Characteristics of approved oral antiviral drugs for chronic hepatitis B treatment

NAs (approval year)	Class effect	Renal effect	Most common adverse events	Laboratory monitoring	Rare severe adverse reactions	Pregnancy category	Detection in breastfeeding
Lamivudine (1998)	Myopathy and neuropathy cases were reported	No significant effect	Upper respiratory tract infection, nasopharyngitis, headache and fatigue ALT flairs CK elevation may occur (usually not requiring cessation of drug)	Serum ALT and bilirubin	Rhabdomyolysis, acute dystonia, pancreatitis Rare lactic acidosis	C	Yes
Telbivudine (2006)	Myopathy and neuropathy cases were reported (especially in combination with Peg- IFN)	Nephroprotective effect Increase in GFR	Upper respiratory tract infection, nasopharyngitis, headache and fatigue Increased incidence of CK elevation (usually asymptomatic and self-limiting, not required cessation of drug)	CK level Serum lactate	Lactic acidosis	B	Yes
Adefovir (2002)	Very rare, No increased incidence of myopathy compared to placebo	Clinically significant nephrotoxicity Decrease in GFR	Pharyngitis, asteni, headache, abdominal pain, flu-like symptoms and nausea	Serum creatinine and phosphate level	Hypophosphatemia Fanconi syndrome	C	Unknown, not recommend for use
Entecavir (2005)	Very rare, No increased incidence of mitochondrial toxicity in combination of entecavir with other NAs and IFN	No decrease in GFR	Headache, upper respiratory tract infection, cough, nasopharyngitis, fatigue, dizziness, upper abdominal pain and nausea	Serum lactate	Lactic acidosis	C	Unknown, not recommend for use
Tenofovir (2008)	Very rare, No increased incidence of myopathy compared to placebo	May decrease GFR, clinically insignificant Nephrotoxic in HIV patients Hypophosphatemia	Headache, nasopharyngitis, back pain, nausea Bone mineral density loss (more prominent in HIV patients)	Serum creatinine and phosphate level BMD		B	Yes

NAs: Nucleos(t)ide analogues; ALT: Alanine aminotransferase; CK: Creatine kinase; IFN: Interferon; GFR: Glomerular filtration rate; HIV: Human immunodeficiency virus; BMD: Bone mineral density.