A comparison of telbivudine and entecavir in the treatment of hepatitis B e antigen-positive patients: a prospective cohort study in China

Abstract

There are few studies directly comparing the efficacy and safety of telbivudine and entecavir. The present prospective cohort study aimed to evaluate the long-term efficacy and safety of these compounds in 196 hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B for a median follow-up period of 172 weeks; 97 were treated with telbivudine and 99 were treated with entecavir. Patients showing suboptimal responses could also take adefovir at 24-48 weeks and all patients with viral breakthrough were started on adefovir. The 240-week cumulative proportions of patients showing undetectable hepatitis B DNA levels and serum alanine transaminase (ALT) normalization were similar in the two study groups. Viral breakthrough developed in 14% of the telbivudine group and in 2% of the entecavir group (p 0.002). Interestingly, the cumulative proportions of patients treated with entecavir and telbivudine showing HBeAg seroconversion were 12% versus 21% at 48 weeks (p 0.041), 15% versus 38% at 96 weeks (p 0.001), 24% versus 50% at 144 weeks (p 0.001), 33% versus 53% at 192 weeks (p 0.004) and 36% versus 53% at 240 weeks (p 0.005), respectively. Patients treated with telbivudine were therefore significantly more likely to show HBeAg seroconversion than those receiving entecavir and similar results were observed in study sub-groups matched for age, serum ALT, and HBV DNA levels. A safety analysis identified no differences between grade 3/4 creatine kinase elevations in the study groups and only telbivudine was associated with improved kidney function.

Long‐term outcome of telbivudine versus entecavir in treating higher viral load chronic hepatitis B patients without cirrhosis

“…The Practice Guidelines recommend HBeAg seroconversion for HBeAg‐positive patients as an ideal endpoint of therapy. Our results showed that the HBeAg seroconversion rate in the LdT group was 63.5%, which was significantly higher than that in the ETV group and was consistent with other reported results …”

“…A sustained suppression of viral replication and the reduction in drug resistance become critical in treating patients . Our results revealed a high HBV DNA negativity with LdT and ETV treatments, which were similar to the results reported by Zhang et al Early viral suppression has significance in predicting the long‐term outcomes of antiviral therapy and improving liver histology in patients with CHB and is consistent with the results reported by Yuen et al…”

“…Zhang et al 17 Early viral suppression has significance in predicting the long-term outcomes of antiviral therapy and improving liver histology in patients with CHB 3,18 and is consistent with the results reported by…”

“…Several observations demonstrated that patients who received LdT treatment had higher rates of HBV DNA negativity, HBeAg seroconversion and rapid viral response . LdT might impact immunity in CHB patients.…”

“…Our results showed that the HBeAg seroconversion rate in the LdT group was 63.5%, which was significantly higher than that in the ETV group and was consistent with other reported results. 17,21 Hepatitis B surface antigen seroconversion during or after anti-…”