Telbivudine for the Treatment of Hepatitis B Disease

Chronic hepatitis B affects approximately 350 million individuals worldwide leading to approximately 500,000 deaths annually. Current therapy includes immune modulators such as IFN-α and the oral antiviral agents, nucleoside analogs such as lamivudine and entecavir, and nucleotide analogs such as adefovir and tenofovir. Recently, telbivudine was approved in the USA for treatment of HBV disease. It is a synthetic nucleoside analog of thymidine that requires phosphorylation to convert to the active triphosphate form. Telbivudine is rapidly absorbed with a long half-life allowing for once-daily dosing. Clinical trials have demonstrated superior antiviral efficacy compared with lamivudine. Telbivudine has shown good correlations between antiviral efficacy at 24 weeks and a favorable outcome at 2 years. Telbivudine is well-tolerated, although monitoring for myopathies is recommended. Telbivudine resistance rates were lower compared with lamivudine. Telbivudine is an option for monotherapy in naive patients or for use in combination therapy in the treatment of chronic hepatitis B.