Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B

Kim, Eun Hye; Park, Hana; Lee, Kun Ho; Ahn, Sang Hoon; Kim, Seung Min; Han, Kwang Hyub

doi:10.3350/cmh.2013.19.1.82

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…Kim et al 7 reported the telbivudine-induced myopathy of siblings, in whom muscle biopsy was not performed. The duration of telbivudine treatment in their patients was relatively shorter than our series -9 and 13 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Mitochondrial myopathies caused by prolonged use of telbivudine

Lee

Shin

Park

et al. 2017

Ann Clin Neurophysiol

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Background:Telbivudine is a nucleoside analogue used for the treatment of chronic hepatitis B, but it often develops mitochondrial toxicity leading to symptomatic myopathy. In this study, three patients with telbivudine induced myopathy were enrolled in order to investigate the nature and pathogenesis of mitochondrial toxicity caused by long-term use of telbivudine. Methods: Clinical features, laboratory findings, muscle pathology, and quantitation of mitochondrial DNA were studied in three patients. Results: Patients presented with progressive muscle weakness with high serum creatine kinase levels. Light microscopic findings of muscle pathology showed ragged red fibers that reacted strongly with succinate dehydrogenase stain, but negative for cytochrome c oxidase activities. Electron microscopy revealed abnormal mitochondrial accumulation with rod shaped inclusions. The quantitative peroxidase chain reaction showed a depletion of mitochondrial DNA in skeletal muscle of the patients. Conclusions: Nucleoside analogues including telbivudine are potent inhibitors of viral DNA polymerases. However, they are not specific for viral DNA and can disturb mitochondrial replication at the same time. All nucleotide analogues should be used with close clinical observation in order to avoid development of mitochondrial myopathy.

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Section: Discussionmentioning

confidence: 99%

“…5,6 However, previous pathological reports on telbivudine-induced myopathy did not clearly reveal the evidence of mitochondrial toxicity. 7,8 Here, we showed that the myopathy induced by prolonged use of telbivudine is a mitochondrial myopathy caused by disturbed replication of mitochondrial DNA.…”

Section: Introductionmentioning

confidence: 99%

Mitochondrial myopathies caused by prolonged use of telbivudine

Lee

Shin

Park

et al. 2017

Ann Clin Neurophysiol

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“…42,46 Telbivudine and clevudine are comparable to entecavir in their antiviral potency but are currently not recommended owing to the frequent development of antiviral resistance and serious muscle-related problems. 42,[46][47][48][49] Entecavir and tenofovir DF have been the preferred antiviral agents for more than a decade since their approval for CHB treatment. Recently, these drugs were compared in terms of long-term treatment outcomes, especially for the prevention of HCC.…”

Section: Nasmentioning

confidence: 99%

“…For example, switching to entecavir or tenofovir DF is a reasonable option for clevudine-or telbivudine-associated myopathy. 48,49,64 Among the high genetic barrier drugs preferred as first-line agents for CHB treatment, tenofovir DF has an increased risk of renal and bone toxicity. 65 The KASL recommends substituting tenofovir DF with entecavir, tenofovir AF, or besifovir in such patients based on previous treatment history.…”

Section: Adverse Effectsmentioning

confidence: 99%

Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop

et al. 2020

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Clinical practice guidelines are important for guiding the management of specific diseases by medical practitioners, trainees, and nurses. In some cases, the guidelines are utilized as a reference for health policymakers in controlling diseases with a large public impact. With this in mind, practice guidelines for the management of chronic hepatitis B (CHB) have been developed in the United States, Europe, and Asian-Pacific regions to suggest the best-fit recommendations for each social and medical circumstance. Recently, the Korean Association for the Study of the Liver published a revised version of its clinical practice guidelines for the management of CHB. The guidelines included updated information based on newly available antiviral agents, the most recent opinion on the initiation and cessation of treatment, and updates for the management of drug resistance, partial virological response, and side effects. Additionally, CHB management in specific situations was comprehensively revised. This review compares the similarities and differences among the various practice guidelines to identify unmet needs and improve future recommendations.

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“…There have been 20 telbivudine-induced myopathy (TIM) cases reported in the literature with detailed descriptions of clinical, imaging, or pathological features. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Two small case series included three and four patients, but for the others only a single case was reported. Little is currently known about the risk factors for this severe adverse event related to telbivudine treatment.…”

Section: Introductionmentioning

confidence: 99%

Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors

Lan

Lin

et al. 2023

J Clin Neurol

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Background and Purpose Oral nucleos(t)ide analogs (NAs) are the mainstay treatment for chronic hepatitis B (CHB). Myotoxicity is an important extrahepatic effect related to NA treatment. Telbivudine is the NA for CHB that is frequently associated with muscle-related side effects. The risk factors for telbivudine-induced myopathy (TIM) are not yet clear. Methods This study characterized the clinical, magnetic resonance images (MRI), and pathological features of 12 TIM cases. A group of telbivudine-tolerant (TT) patients with CHB who received regular telbivudine treatment during the same period without the occurrence of myopathy was collected. Demographic and clinical factors were compared between the patients with TIM and the TT controls. Factors independently associated with TIM were identified using logistic regression analysis. Results The patients with TIM (males/females: 7/5, mean age: 57 years) developed myopathy after using telbivudine for a median period of 19.5 months. Muscle histopathology revealed abnormal proliferation, subsarcolemmal or sarcoplasmic accumulations, and ultrastructural defects of mitochondria. When compared with TT cases, patients with TIM had a lower estimated glomerular filtration rate and were more frequently positive for hepatitis B e antigen (HBeAg). Conclusions Mitochondrial abnormalities are characteristic histopathological features, and impaired renal function and HBeAg positivity are risk factors for TIM. Telbivudine-induced mitochondrial dysfunction and immune activation related to mitochondrial damage and HBeAg serostatus changes may underlie TIM. Constant clinical surveillance of myopathy during telbivudine treatment is needed due to the significant latency of its development. Dose adjustment for impaired renal function does not eliminate the risk of TIM occurrence.

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Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B

Cited by 11 publications

References 24 publications

Mitochondrial myopathies caused by prolonged use of telbivudine

Mitochondrial myopathies caused by prolonged use of telbivudine

Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop

Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors

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