Treatment of hepatitis B e antigen-positive chronic hepatitis with telbivudine or adefovir: A randomized trial

Henry L.Y. Chan, E. Jenny Heathcote, Patrick Marcellin, Ching Lung Lai, Mong Cho, Young M. Moon, You Chen Chao, Robert P. Myers, Gerald Y. Minuk, Lennox Jeffers, William Sievert, Natalie Bzowej, George Harb, Ralf Kaiser, Xin Jian Qiao, Nathaniel A. Brown, Darrell Crawford, Seng Gee Lim, Anuchit Chutaputti, Thierry Poynard

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Abstract

Background: The efficacy of nucleoside and nucleotide analogues for hepatitis B has been linked to the magnitude and durability of hepatitis B virus (HBV) suppression. Objective: To compare the antiviral efficacy of telbivudine and adefovir dipivoxil, and the effects of switching from adefovir to telbivudine, in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B. Design: Randomized, controlled, open-label trial. Setting: 16 outpatient clinics. Patients: 135 treatment-naive, HBeAg-positive adults with chronic hepatitis B. Intervention: Patients were randomly assigned in a 1:1:1 ratio to 52 weeks of telbivudine (group A) or adefovir (group B), or 24 weeks of adefovir and then telbivudine for the remaining 28 weeks (group C). One hundred thirty-one patients completed 52 weeks of treatment. Measurements: The primary efficacy comparison was serum HBV DNA reduction at week 24, with a secondary comparison at week 52. Results: At week 24, mean HBV DNA reduction was greater in group A than in pooled groups B and C (-6.30 vs. -4.97 log10 copies/mL; difference, -1.33 log10 copies/mL [95% CI, -1.99 to -0.66 log10 copies/mL]; P < 0.001), and more patients in group A were polymerase chain reaction-negative (39% vs. 12%; odds ratio, 4.46 [CI, 1.86 to 10.72]; P < 0.001). At week 52, the mean residual HBV DNA level was lower in group A and group C than in group B (3.01 log10 copies/mL [group A] and 3.02 log10 copies/mL [group C] vs. 4.00 log10 copies/mL [group B]; difference, -0.99 log10 copies/mL [CI, -1.67 to -0.32 log10 copies/mL] and -0.98 log10 copies/mL [CI, -1.64 to -0.32 log10 copies/mL]; P = 0.004). Adverse events were similar across groups; the most common were upper respiratory symptoms, headache, back pain, and diarrhea. Limitations: The trial was open-label and was not of sufficient size or duration to compare clinical outcomes and long-term efficacy. Conclusion: Telbivudine demonstrated greater and more consistent HBV DNA suppression than adefovir after 24 weeks of treatment. After 52 weeks, HBV DNA suppression was greater in patients who had received continuous telbivudine or were switched to telbivudine after 24 weeks than in those who received continuous adefovir.

Original languageEnglish (US)
Pages (from-to)745-754
Number of pages10
JournalAnnals of internal medicine
Volume147
Issue number11
DOIs
StatePublished - Dec 4 2007

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ASJC Scopus subject areas

  • Internal Medicine

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Chan, H. L. Y., Heathcote, E. J., Marcellin, P., Lai, C. L., Cho, M., Moon, Y. M., Chao, Y. C., Myers, R. P., Minuk, G. Y., Jeffers, L., Sievert, W., Bzowej, N., Harb, G., Kaiser, R., Qiao, X. J., Brown, N. A., Crawford, D., Lim, S. G., Chutaputti, A., & Poynard, T. (2007). Treatment of hepatitis B e antigen-positive chronic hepatitis with telbivudine or adefovir: A randomized trial. Annals of internal medicine, 147(11), 745-754. https://doi.org/10.7326/0003-4819-147-11-200712040-00183