Efficacy of sequential use of telbivudine in hepatitis <scp>B</scp> e antigen‐positive chronic hepatitis <scp>B</scp> patients with partial responses to pegylated interferon: a pilot study

Huang, Zheping; Zhao, Zhigang; Zheng, Yanhua; Peng, Liang; Lin, Chen‐Chun; Deng, Haijun; Gao, Zhiliang

doi:10.1111/jvh.12064

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…IFN is an antiviral drug commonly used to treat HBV, due to its dual effects of immunoregulation and viral suppression[23]. The dosage and treatment duration also have important effects on the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Antiviral Therapy for Hepatitis B Virus-Associated Membranous Nephropathy

Yang

Chen

et al. 2016

PLoS ONE

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Hepatitis B virus-associated membranous nephropathy (HBV-MN) is the most common renal extra-hepatic manifestation in patients with chronic HBV infection. In September 2015, we searched the MEDLINE, EMBASE, and CENTRAL databases, and the reference lists of retrieved articles, to identify relevant studies. Descriptions of antiviral drugs used to treat HBV-MN were included in our review. Two authors independently screened all relevant articles, extracted data, and assessed the risk of bias. Nine hundred and fifty-four papers have been considered after electronic and manual searching, only five relevant studies were identified. Complete remission (OR = 26.87, 95% CI: 8.06 to 89.52), total remission (OR = 10.31, 95% CI: 3.59 to 29.63) of proteinuria and HBeAg clearance (OR = 20.91, 95% CI: 6.90 to 63.39) increased significantly after antiviral therapy. No significant differences were seen between interferon and nucleoside analog treatments. Our study found that antiviral therapy was an effective treatment in HBV-MN patients; interferon and nucleoside analogs were equally effective at causing proteinuria remission and HBeAg clearance.

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Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Antiviral Therapy for Hepatitis B Virus-Associated Membranous Nephropathy

Yang

Chen

et al. 2016

PLoS ONE

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“…Research by Fried MW et alshowed that in a study of 265 patients with HBeAg‐positive CHB treated with Peg‐IFNα‐2a for 48 weeks before suspension for 24 weeks, only 16% of patients in the group with HBV DNA levels greater than 5.0 lg copies/mL achieved HBeAg seroconversion. Studies also suggested that switching from Peg‐IFNα‐2a to telbivudine was not only well tolerated and safe but also had a higher HBeAg seroconversion rate compared with both telbivudine monotherapy and Peg‐IFNα‐2a monotherapy …”

Section: Discussionmentioning

confidence: 99%

“…In addition to direct antihepatitis B virus treatment, the immunological effects of telbivudine sequential use after Peg‐IFN have been evaluated and appear to promote HBeAg seroconversion during treatment of CHB, which however requires further study to clarify the mechanism of action and key targets. This is consistent with the results of a study by Huang et al…”

Section: Discussionmentioning

confidence: 99%

“…HBeAg‐positive CHB patients with suboptimal responses to 24 weeks of Peg‐IFNα‐2a therapy with HBsAg ≥20 000 IU/ml and HBVDNA ≥5.0 lg copies/mL have been recommended to receive additional or replacement therapy with nucleoside analogues …”

Section: Introductionmentioning

confidence: 99%

“…HBeAg-positive CHB patients with suboptimal responses to 24 weeks of Peg-IFNα-2a therapy with HBsAg ≥20 000 IU/ml and HBVDNA ≥5.0 lg copies/mL have been recommended to receive additional or replacement therapy with nucleoside analogues. 8 Several domestic and international studies have shown that patients previously treated with Peg-IFNα-2a who switched to telbivudine have had good tolerability and safety as well as good virological responses and HBeAg seroconversion rates. 8,9 Most of these were retrospective studies with durations of generally 104 weeks or less.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of 208‐week sequential therapy with telbivudine and entecavir in HBeAg‐positive chronic hepatitis B patients with suboptimal responses to 24 weeks of Peg‐IFNα‐2a therapy: An open‐labelled, randomized, controlled, “real‐life” trial

Luo

Chen

Zhou

2017

Journal of Viral Hepatitis

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The purpose of the study was to compare the efficacy and safety of 208-week sequential therapy with telbivudine and entecavir in HBeAg-positive chronic hepatitis B (CHB) patients with suboptimal responses to 24 weeks of Peg-IFNα-2a therapy. This was an open-label, randomized, controlled, "real-life" trial. HBeAg-positive CHB patients with serum HBV DNA ≥5.0 lg IU/mL and a < 1 lg IU/mL decline of HBsAg level from baseline who underwent at least 24 weeks of Peg-IFNα-2a therapy were included. Enrolled patients were randomized to receive either telbivudine (600 mg/d, n = 95) or entecavir (0.5 mg/d, n = 95) for 208 consecutive weeks. Six patients were lost to follow-up (4 patients in the telbivudine group and 2 in the entecavir group). Treatment was combined with adefovir when week 24 HBV DNA levels declined to <2 lg IU/mL versus baseline, when viral breakthrough occurred during treatment,or when HBV DNA remained detectable at 52 weeks (HBV DNA ≥500 IU/mL). Responses and safety were assessed after 208 weeks of treatment. There were no significant differences among the baseline characteristics, including age, gender, and ALT, HBV DNA, HBsAg or HBeAg levels. After 208 weeks of treatment, there was no significant difference in the rates of undetectable HBV DNA (HBV DNA<500 IU/mL) between the telbivudine group and the entecavir group (84/91,92.31% vs 88/93,94.62%, respectively, P = .525). More patients in the telbivudine group than the entecavir group achieved HBeAg clearance (74.73% vs 46.24%, respectively, P < .001) and HBeAg seroconversion (64.84% vs 38.71%, respectively, P < .001). Univariate analysis (Enter, a = 0.05) of both groups showed that telbivudine, male gender and baseline HBeAg levels were significantly correlated with HBeAg seroconversion after 208 weeks of sequential therapy. Cox regression analysis (Enter, a = 0.05) of the telbivudine group showed that the HBeAg seroconversion rate at 208 weeks was significantly correlated with gender (male) (P = .006, HR=4.406), baseline HBeAg level (P = .005, HR=0.433) and 24 w-HBeAg level reduction of more than 0.5 lg IU/ml from baseline (P = .027, HR=0.487). All patients tolerated sequential telbivudine treatment; only slightly elevated creatine kinase levels were observed. Stratification analysis found that patients with baseline HBeAg levels less than 3 lg COI who switched to telbivudine may have had significantly improved HBeAg seroconversion rates. In conclusion, telbivudine promotes HBeAg seroconversion that merits investigation in HBeAg-positive CHB patients with suboptimal responses to 24 weeks of Peg-IFNα-2a therapy. We would suggest that patients with baseline HBeAg levels under 3 lg COI switch to telbivudine to achieve higher HBeAg seroconversion rates and use the early reductions in HBeAg levels (24 weeks) to guide treatment.

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

Zhang

et al. 2016

Clinical Microbiology and Infection

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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.

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Efficacy of sequential use of telbivudine in hepatitis B e antigen‐positive chronic hepatitis B patients with partial responses to pegylated interferon: a pilot study

Cited by 8 publications

References 17 publications

A Meta-Analysis of Antiviral Therapy for Hepatitis B Virus-Associated Membranous Nephropathy

A Meta-Analysis of Antiviral Therapy for Hepatitis B Virus-Associated Membranous Nephropathy

Comparison of 208‐week sequential therapy with telbivudine and entecavir in HBeAg‐positive chronic hepatitis B patients with suboptimal responses to 24 weeks of Peg‐IFNα‐2a therapy: An open‐labelled, randomized, controlled, “real‐life” trial

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

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