Telbivudine therapy for chronic hepatitis B: A journey to identify super-responders and to optimize treatment using the roadmap model
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
32
Journal Issue
1
Pages
73-81
Date Issued
2017
Author(s)
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 log10 copies/mL (2 × 108 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 log10 copies/mL (2 × 106 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. ? 2016 The Authors Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd
Subjects
hepatitis B virus infection; nucleos(t)ides analogs; prediction; treatment response; viral load
SDGs
Other Subjects
adefovir; alanine aminotransferase; creatine kinase; hepatitis B(e) antigen; lamivudine; telbivudine; virus DNA; alanine aminotransferase; antivirus agent; biological marker; hepatitis B(e) antigen; telbivudine; thymidine; virus DNA; adverse drug reaction; antiviral resistance; chronic hepatitis B; creatine kinase blood level; drug efficacy; drug safety; drug treatment failure; general condition improvement; Hepatitis B virus; human; meta analysis (topic); multicenter study (topic); optimal drug dose; phase 3 clinical trial (topic); physician; pregnant woman; priority journal; randomized controlled trial (topic); Review; risk reduction; systematic review (topic); treatment response; analogs and derivatives; blood; drug administration; genetics; Hepatitis B, Chronic; predictive value; risk; treatment failure; treatment outcome; virology; Alanine Transaminase; Antiviral Agents; Biomarkers; DNA, Viral; Drug Administration Schedule; Hepatitis B e Antigens; Hepatitis B virus; Hepatitis B, Chronic; Humans; Predictive Value of Tests; Risk; Thymidine; Treatment Failure; Treatment Outcome
Publisher
Blackwell Publishing
Type
review