Provincial People’s Hospital, Xi’an, China.
J Viral Hepat. 2013 Apr;20 Suppl 1:46-51. doi: 10.1111/jvh.12063.
Telbivudine (LdT) has demonstrated potent antiviral activity in nucleos(t)ide analogue (NA)-naïve chronic hepatitis B patients (CHB), but data on its efficacy in NA-experienced patients are limited. The aim of this study was to investigate the effect of LdT in hepatitis B e antigen-positive CHB patients with poor response to initial adefovir dipivoxil (ADV). Forty-two CHB patients with HBV DNA > 4 log10 copies/mL after 12 months of ADV monotherapy were enroled in the study and thereafter treated with LdT 600 mg daily for 18 months. Telbivudine led to a rapid decrease in viral load, and viral replication was persistently suppressed with a reduction of 2.26 log10 copies/mL 18 months after LdT treatment. The rates corresponding to virological and biochemical response at the end of observation were 97.6% (41/42) and 65.8% (25/38), respectively. HBeAg loss was found in 30.8% (12/39) of patients, while HBeAg/anti-HBe seroconversion was found in 17.9% (7/39). Only one patient was detected to have LdT-associated mutation, and no severe adverse events were reported. Optimization therapy with LdT monotherapy may be a good choice for CHB patients with poor response to ADV, and switching to LdT may be the most cost-effective rescue therapeutic strategy for patients with poor response to initial ADV monotherapy.
替比夫定（LdT）在核苷（酸）类似物（NA）初治慢性乙型肝炎（CHB）患者中显示出很强的抗病毒活性，但在 NA 经治患者中的疗效数据有限。本研究旨在探讨替比夫定在阿德福韦酯（ADV）初始单药治疗应答不佳的 HBeAg 阳性 CHB 患者中的疗效。42 例 ADV 单药治疗 12 个月后 HBV DNA > 4 log10 拷贝/mL 的 CHB 患者入组本研究，并随后接受替比夫定 600mg 每日治疗 18 个月。替比夫定可迅速降低病毒载量，治疗 18 个月后病毒复制持续受到抑制，HBV DNA 下降 2.26 log10 拷贝/mL。观察结束时的病毒学和生化学应答率分别为 97.6%（41/42）和 65.8%（25/38）。30.8%（12/39）的患者出现 HBeAg 丢失，17.9%（7/39）的患者出现 HBeAg/抗-HBe 血清学转换。仅 1 例患者检测到替比夫定相关突变，无严重不良事件发生。替比夫定单药优化治疗可能是 ADV 应答不佳的 CHB 患者的良好选择，而替比夫定转换可能是初始 ADV 单药治疗应答不佳患者最具成本效益的挽救治疗策略。
