There are now two licensed therapies for chronic hepatitis B: interferon α and lamivudine. Interferon α was first shown to have activity against hepatitis B in 1976,1 but was not formally approved for use in chronic hepatitis B until 1992. The currently recommended regimen for interferon is 5 million units (mu) given daily or 10 mu given three times a week by subcutaneous (sc) injection for four to six months. This regimen results in long term beneficial responses in roughly 33% of patients.2 3

Lamivudine was first shown to have activity against hepatitis B virus (HBV) in 19924 and was approved for use in chronic hepatitis B in 1998. The currently recommended regimen for lamivudine is 100 mg given daily by mouth for one year. This regimen results in beneficial responses in 16–20% of patients with typical chronic hepatitis B.5-7

Thus, there are now two choices for therapy. Which should be used? Which should be used first? Should the second be tried if the first fails? What about combining the two? These are simple questions, but they do not have simple answers.

In this issue (see page 562), Schalm and collaborators report results of a large, multinational, randomised, double blind, placebo controlled trial of lamivudine, interferon α and the combination of both in 230 patients with typical chronic hepatitis B. This trial was one of the largest studies ever conducted in hepatitis B and was large enough to have answered the questions posed above, at least in part. In the study, 18% of patients receiving lamivudine alone, 19% receiving interferon …