ASK DIS: Outcomes of Telbivudine Treatment Interuption

Thursday, August 6, 2015

optimal duration of therapy for the oral drugs is not well-established.
Most patients receiving nucleos/tideanalogue therapy will require at least four to five years of treatment, and some may require indefinite treatment.
Long-term treatment is particularly important for patients with cirrhosis

HBeAg-positive chronic hepatitis

The endpoint of treatment is HBeAg seroconversion.
Patients in whom HBeAg seroconversion has occurred and serum HBV DNA has become undetectable should be treated for at least 6-12 more months after HBeAg seroconversion has been confirmed (by testing on two occasions at least two months apart) to reduce the rate of relapse
many studies have shown that 50%-70% of patients will remain in remission (low or undetectable serum HBV DNA and normal ALT) for many years if the above recommendation is followed

HBeAg-negative chronic hepatitis

Treatment may be discontinued in patients who have confirmed loss of HBsAg (by testing on two occasions at least two months apart).
However, only a small minority of patients (approximately 5 percent) lose HBsAg after five years of continued therapy

Compensated cirrhosis

The aim of treatment is to prevent liver failure and HCC.
Thus, life-long treatment is generally recommended.
It is possible that treatment may be discontinued in those who have lost HBsAg.
It is not clear if treatment can be discontinued in HBeAg-positive patients who have achieved HBeAg seroconversion and completed at least 12 months of consolidation therapy

Decompensated cirrhosis

Predictor of Response to telbivudine

The best predictor of treatment outcome in HBeAg positive and HBeAg negative chronic hepatitis B virus (HBV) infection treated with telbivudine appears to be non-detectable serum HBV DNA at treatment week 24.
No other specific indicator on the risks of mortality or morbidity based on duration or timing of interuptions

References:

ASK DIS