Thursday, August 6, 2015

Outcomes of Telbivudine Treatment Interuption

  • 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 
  • Life-long treatment is recommended

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:
  1. http://www.hivandhepatitis.com/hep_b/news/2009/032709_aa.html
  2. www.uptodate.com

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