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21. Are there other notable differences between the treatments, including side-effects?

Now the route of administration, this is subcutaneous, the other two are oral. Side effects are many, interferon causes flu-like symptoms, aching, and tiredness. It causes psychiatric and psychological changes in 30% of patients, that’s either irritability, or depression, or sleep disturbance, or all three and it can lower the blood counts. Both lamivudine and adefovir in the pivotal trials- the drug equals placebo, in other words, when they analyzed all of the side-effects, headache, stomachache, diarrhea, fever, you name it, there was no difference between people who got the drug and the dummy tablet. We all get headaches every now and then, so you have to always have that control group that gets the placebo. So these virtually have no side effects. Therefore, there’s no contraindication, except here, interferon you cannot use this in people who have serious psychiatric disease or have other auto-immune disease like rheumatoid arthritis. Now, the advantage of interferon is there is no resistance, where here it’s 20% in one year, goes up to 70% in 5 years. This is really the Achilles heal of lamivudine therapy is this resistance rate. Lower rate here. Cost, these are all expensive therapies, interferon is quite expensive. Lamivudine is about $100-$150 per month, adefovir is about $400-$450 per month, so it is three times as expensive.