Telbivudine in the treatment of chronic hepatitis B virus infection
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
Telbivudine (L-deoxythymidine [LdT or Tyzeka]) is the unmodified beta-L enantiomer of thymidine. It is approved for the treatment of chronic hepatitis B virus (HBV) in adults with evidence of viral replication and either persistent elevation in serum aminotransferases or histologically active disease.
The treatment of chronic hepatitis B with telbivudine will be reviewed here. A general approach to patients with hepatitis B (including other treatment options) is presented separately. (See "Overview of the management of hepatitis B and case examples".)
HBeAg POSITIVE HBV
The available data suggest that telbivudine is slightly more effective than lamivudine in suppressing HBV DNA in patients who are HBeAg positive but the benefit does not appear to translate into a clinically important advantage for HBeAg seroconversion or histologic improvement.
The largest trial (the 007 GLOBE trial) included 1367 patients who were HBsAg positive, HBeAg positive (n = 797) or negative (n = 417), had an alanine aminotransferase (ALT) level >1.3 times the upper limit of normal, had not previously received nucleoside analogues, and had a liver biopsy compatible with chronic viral hepatitis . The mean baseline HBV DNA level was 9.5 log10 copies/mL in those who were HBeAg positive and 7.7 log10 copies/mL in those who were HBeAg negative.
The patients were randomly assigned to telbivudine (600 mg once daily) or lamivudine (100 mg once daily) for up to 104 weeks. The following observations were made in the HBeAg positive group at week 52:
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