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Telbivudine therapy for chronic hepatitis B: A journey to identify super‐responders and to optimize treatment using the roadmap model
Author(s) -
Kao JiaHorng,
Asselah Tarik,
Dou XiaoGuang,
Hamed Kamal
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13512
Subject(s) - telbivudine , medicine , hbeag , chronic hepatitis , cirrhosis , hepatitis b , hepatitis b virus , gastroenterology , alanine aminotransferase , drug resistance , immunology , lamivudine , virus , hbsag , microbiology and biotechnology , biology
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.