The government should come up with measures to better manage elderly patients with hepatitis B, said Yoon Goo-hyeon, head of Liver Korea, a group of patients with liver diseases.
Hepatitis B has been the primary cause of acute hepatitis, chronic hepatitis, cirrhosis, and hepatocellular carcinoma since the 1970s. However, the nation reduced the prevalence of hepatitis B significantly through immunizations for all citizens, projects to prevent vertical transmissions, and a surveillance system.
|Yoon Goo-hyeon, head of Liver Korea, a group of patients with liver diseases|
In 2008, Korea received the World Health Organization’s certification for hepatitis B management for the first time in the Western Pacific region. Despite the lowered prevalence, numerous patients with hepatitis B are still fighting the disease.
According to the National Health Insurance Service, 387,789 patients received treatment due to hepatitis B in 2018. Effective treatments have made it easier to manage hepatitis B and improved mortality. Consequently, patients have become more aged than in the past.
“The number of new patients with hepatitis B has significantly decreased, as screening and prevention of the disease became a national policy,” Yoon said. “The incidence of liver cancer caused by hepatitis B is smaller than in the past, and the number of deaths by cirrhosis also went down to one-sixth.”
Ironically, the number of aged patients with hepatitis B instead increased, and now is not the time to stop worrying about chronic hepatitis B yet, he noted.
Many people suffering from chronic hepatitis B take medications for 20 or 30 years, and they need more attention for controlling complications and the quality of life, Yoon emphasized.
Zeffix, which came in the market at an early stage, is the most common drug to which Korean hepatitis B patients are resistant, he noted. Although the drug itself has a high expression of drug resistance, the government recognized the reimbursement for the monotherapy of the drug, only for the short term, which was why the nation failed to curtail drug resistance, he added.
Not to make another mistake of failing to respond to the problem at the initial stage, the government should become more active in managing aged patients’ complications, Yoon claimed.
He suggested allowing physicians to change medications to help patients better manage complications.
“Even if a patient wants to switch the drug from existing Viread(ingredient: tenofovir DF) or Baraclude (entecavir) to Besivo (besifovir) or Vemlidy (tenofovir AF) because of the worries over weaker kidney function or decreased bone density, the switch is allowed only when the patient’s renal function fails significantly,” Yoon said. “We need a policy that takes into account a situation where patients who take the medication for a lifetime get old.”
Many patients also worry about an increase in low-density lipoprotein (LDL)-cholesterol due to their medications.
Yoon called for a measure to relieve concerns for chronic diseases that hepatitis B patients may develop in the long term.
In fact, one study found that besifovir improved side effects of decreased renal function and bone density, compared to entecavir and tenofovir AF.
However, only newly diagnosed patients can benefit from insurance coverage for besifovir. For patients who were on other medications to switch to besifovir, they should prove that their renal function and bone density fell below the level of eGFR(estimated glomerular filtration rate) 60 mL/min, and below the T-score of minus 2.5, respectively.
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