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Telbivudine Tops Lamivudine for Chronic Hepatitis B

Greater antiviral efficacy and lower resistance rates than lamivudine

WEDNESDAY, Dec. 19 (HealthDay News) -- In patients with chronic hepatitis B who are hepatitis B e antigen (HBeAg) positive, telbivudine is associated with improved rates of therapeutic response, and, regardless of HBeAg status, superior viral suppression and less development of resistance compared to lamivudine, according to an article published in the Dec. 20 issue of the New England Journal of Medicine.

Ching-Lung Lai, M.D., of Queen Mary Hospital in Hong Kong, China, and colleagues conducted a double-blind, randomized, multi-center, international trial in which 1,370 patients with chronic hepatitis B received either daily telbivudine or lamivudine. Primary endpoints included therapeutic response, defined as a decrease in serum hepatitis B virus (HBV) DNA levels to less than 5 log10 copies per milliliter, loss of HBeAg, and normalization of alanine aminotransferase levels.

After 52 weeks of treatment, compared to lamivudine, telbivudine resulted in superior rates of therapeutic response (75.3 percent versus 67 percent) and histologic response (64.7 percent versus 56.3 percent) in HBeAg-positive patients. Among HBeAg-negative patients, rates of therapeutic and histologic response were similar in the two groups. Regardless of HBeAg status, telbivudine was associated with higher rates of suppression of HBV DNA to undetectable levels, and less development of resistance than lamivudine. More patients on telbivudine developed elevated creatine kinase levels, whereas liver transaminase elevations were more common with lamivudine.

"These results support telbivudine as an effective therapy for patients with chronic hepatitis B," the authors conclude.

This trial was funded by Idenix Pharmaceuticals and Novartis Pharmaceuticals. Several study authors report financial relationships with the pharmaceutical industry.

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