Telbivudine therapy for chronic hepatitis B: A journey to identify super‐responders and to optimize treatment using the roadmap model

Abstract

Hepatitis B virus (HBV) infection is one of the most serious health problems worldwide with a high risk for cirrhosis and liver cancer. Several antiviral agents have been approved for the treatment of chronic hepatitis B, leading to a rapid reduction in HBV DNA and normalization of serum alanine aminotransferase levels. Telbivudine, a potent inhibitor of HBV replication, has been shown to be well tolerated. Because of the emergence of drug resistance, optimization strategies for telbivudine therapy have been shown to improve patient responses. Optimal baseline characteristics in so-called super-responders have been used to predict the virological response. Baseline HBV DNA levels < 9 log 10 copies/mL (2 × 10 8 IU/mL) or alanine aminotransferase levels of more than or equal to twofold the upper limit of normal in HBeAg-positive patients and HBV DNA < 7 log 10 copies/mL (2 × 10 6 IU/mL) in HBeAg-negative patients were strong predictors for virological response. In addition, the roadmap model, based on early virological response at week 24 of therapy, is considered as a powerful tool to identify patients at risk of treatment failure (HBV DNA ≥ 300 copies/mL, i.e. 60 IU/mL) and to reduce the risk of antiviral resistance. When considering pre-treatment characteristics and on-treatment responses, telbivudine may provide physicians with a wide choice of options to effectively treat patients with chronic hepatitis B, especially those with or at risk of renal impairment, or women of childbearing age.

Comparison of HBV DNA Quantitative Log in Patients Hepatitis B with Telbivudine Therapy Compared with Tenofovir Therapy in Saiful Anwar General Hospital Malang: January 2016 - December 2017

“…[13] Mild ALT levels and low HBV DNA levels (eg <20,000 IU / mL for HBeAg-positive and <2,000 IU / mL for HBeAg-negative patients) can be predictors of the long-term benefit and safety profile of anti-HBV therapy. [14] In this study, the results of multiple logistic regression analysis showed a significant difference between the administration of Telbivudine as a hepatitis B treatment with lower serum HBV DNA levels compared to the administration of Tenofovir at the 12-month follow-up therapy.…”

Kinetics of hepatitis B surface antigen and estimated glomerular filtration rate in telbivudine-treated hepatitis B patients with different rescue strategies

“…According to international guidelines and the roadmap concept, both the addition of a nucleotide analogue or simply switching to a more potent drug are suggested for chronic hepatitis B (CHB) patients receiving telbivudine (LdT) therapy who exhibit drug resistance or an insufficient response [1][2][3][4][5]. Switching to tenofovir disoproxil fumarate (TDF) is also regarded as the appropriate rescue therapy for patients with LdT-related myopathy or neuropathy [6,7].…”

Adenovirus Vector Harboring the HBcAg and Tripeptidyl Peptidase II Genes Induces Potent Cellular Immune Responses In Vivo

“…Hepatitis B virus infection causes chronic hepatitis and complications that can pose serious hazards to human health worldwide [1,2]. As reported by the World Health Organization, approximately 2 billion people have been infected with the hepatitis B virus [3], with over 400 million people developing chronic hepatitis [4,5].…”