Drug and dosage*	Cautions and monitoring of treatment	Potential adverse effects and monitoring of treatment	Effect	Cost†
Pegylated interferon alfa-2a (Pegasys), interferon alfa-2b (Intron A)  Adults (pegylated interferon alfa-2a): 180 mcg subcutaneously per week for 48 weeks  Children one year or older (interferon alfa-2b): 3 million IU per m2 subcutaneously three times per week, followed by 6 million IU per m2 subcutaneously three times per week, for a total duration of 16 to 24 weeks (maximal dose: 10 million IU)  Children three years and older (pegylated interferon alfa-2a): 180 mcg per 1.73 m2 × body surface area once weekly for 48 weeks (maximal dose: 180 mcg)	May cause or exacerbate autoimmune, infectious, ischemic, thyroid, and neuropsychiatric disorders, and hemorrhagic cerebrovascular events Use caution in patients with uncontrolled seizure disorder, renal impairment, diabetes mellitus, or cardiovascular disease Monitoring: Complete blood count and chemistries, including liver function tests and uric acid level every one to three months, thyroid-stimulating hormone level every three months, and HBeAg, anti-HBe, serum HBV DNA levels every six months; clinical monitoring for autoimmune, ischemic, neuropsychiatric, and infectious complications	Adults: Flulike symptoms, bone marrow suppression, headache, fatigue Children: Growth suppression (weight, height)	Pegylated interferon alfa-2a had 30% HBeAg seroconversion and HBV DNA suppression compared with placebo Pegylated interferon alfa-2a was superior to lamivudine in HBsAg clearance and seroconversion for patients who were HBeAg positive or negative Patients who were HBeAg negative had significantly higher response rates, sustained for 24 weeks after the cessation of therapy, with peginterferon alfa-2a compared with lamivudine	Adults: — ($4,200) Children: — ($1,830)
Oral antiviral agents (nucleoside/nucleotide analogues)  Adefovir (Hepsera) Adults and children ≥ 12 years: 10 mg orally per day	Use caution in patients with renal impairment or individuals at risk of renal toxicity, including concurrent nephrotoxic agents or nonsteroidal anti-inflammatory drug use Do not use concurrently with tenofovir Not recommended for initial treatment because of low barrier to resistance Should not be used to manage antiviral-resistant hepatitis B Monitoring: Creatinine clearance at baseline; creatinine clearance, serum phosphate, urine glucose, and protein at least annually (if at risk of renal impairment); dual energy x-ray absorptiometry at baseline and during treatment (if history of fracture or at risk of osteopenia); lactic acid levels (if clinical concern); HBV DNA and ALT levels every three months until undetectable, then every three to six months; HBeAg, anti-HBe, HBsAg	Acute renal failure, Fanconi syndrome, nephrogenic diabetes insipidus, lactic acidosis/hepatomegaly	Nucleoside/nucleotide analogues  Had a 43% reduction in HBV DNA level and 48% greater normalization of ALT level compared with placebo  Had a statistically significant higher rate of HBeAg seroconversion, HBeAg loss, and histologic improvement compared with placebo	$500 ($1,450)
Entecavir (Baraclude) Adults: 0.5 to 1 mg orally per day‡ Children > two years: weight based§	Use caution in patients with renal impairment Monitoring: Lactic acid levels (if clinical concern); HBV DNA and ALT levels every three months until undetectable, then every three to six months; HBeAg, anti-HBe, HBsAg	Lactic acidosis/hepatomegaly		$200 ($1,400) for 1 mg
Lamivudine (Epivir HBV) Adults: 100 mg orally per day Children two years or older: 3 mg per kg (maximum: 100 mg) orally per day	Use caution in patients with renal impairment Monitoring: Amylase (if symptomatic); lactic acid levels (if clinical concern); HBV DNA and ALT levels every three months until undetectable, then every three to six months; HBeAg, anti-HBe, HBsAg Not recommended for initial treatment because of low barrier to resistance	Pancreatitis, lactic acidosis/hepatomegaly, immune reconstitution syndrome, headache, fatigue, fat redistribution		$160 ($500) for 100 mg
Telbivudine (no longer available in the United States) Adults: 600 mg orally per day Children: Not approved	Use caution in individuals who did not respond to previous lamivudine therapy and in those with renal impairment Monitoring: Creatine kinase (if symptomatic); lactic acid levels (if clinical concern); HBV DNA and ALT levels every three months until undetectable, then every three to six months; HBeAg, anti-HBe, HBsAg; clinical monitoring for peripheral neuropathy Safety/effectiveness have not been established in blacks or Hispanics	Myopathy, peripheral neuropathy, lactic acidosis/hepatomegaly		— ($1,100)
Tenofovir disoproxil fumarate (Viread) Adults and children ≥ 12 years and ≥ 35 kg (77.2 lb): 300 mg orally per day  Tenofovir alafenamide (Vemlidy) Adults: 25 mg orally per day Children: Not approved	Use caution in patients with renal impairment Monitoring: Same as adefovir	Nephropathy, Fanconi syndrome, osteomalacia, lactic acidosis/hepatomegaly		Tenofovir disoproxil fumarate: $160 ($1,200) Tenofovir alafenamide:— ($1,100)