BACKGROUND: HBsAg clearance is the ultimate goal of antiviral treatment in Chronic Hepatitis B (CHB). Telbivudine (LdT) is a new nucleoside analogue with antiviral activity specific for HBV. The long-term data on the drug efficacy, obtained from the GLOBE trial and the 2303 extension study, showed rapid and powerful antiviral efficacy. In this case report, in agreement with data in literature, LdT showed rapid and efficacy reduction of HBV-DNA levels, persistent (>2 years) PCR negativity, ALT normalization, and HBsAg serum levels decline. Furthermore LdT did not demonstrate side effects and nephrotoxicity . AIM: To demonstrate the efficacy and safety of LdT to induce reduction of ALT serum levels, to promote a rapid HBV-DNA PCR negativization and a progressive reduction of quantitative HBsAg. METHODS: 52-years old Caucasian patient with naïve chronic hepatitis HBV-related (CHB) HBeAg negative. In 2004 patient has been diagnosed as HBV positive with increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels (1.5-2 × ULN). In December 2007 patient attended our Hepatology Unity for the first time. A complete clinical and virological evaluation was performed and then long-term suppressive treatment by Telbivudine (LdT) at the standard dose of 600 mg daily was started. On-treatment monitoring: ALT every month, HBV-DNA and HBsAg serum levels at week 12, 24 and 48 were performed. Follow-up monitoring: monthly ALT serum assay, HBV-DNA and HBsAg index every 3 months. RESULTS: Rapid virological suppression and HBV-DNA PCR negativity were achieved. Persistent PCR HBV-DNA negativity and progressive decline of HBsAg were recorded at week 72. CONCLUSIONS: Long-term suppressive treatment by Telbivudine has a rapid and powerful antiviral efficacy. Pharmakodynamic and kinetics of Ldt suggest that it may represent a viable therapeutic option for patients with CHB and it should now be granted a large space in the therapeutic landscape.

ON-TREATMENT SERUM HBsAG DECLINE DURING TELBIVUDINE THERAPY IN NAÏVE CHRONIC HEPATITIS B: CASE REPORT

BERTINO, Gaetano;NERI, Sergio
2010

Abstract

BACKGROUND: HBsAg clearance is the ultimate goal of antiviral treatment in Chronic Hepatitis B (CHB). Telbivudine (LdT) is a new nucleoside analogue with antiviral activity specific for HBV. The long-term data on the drug efficacy, obtained from the GLOBE trial and the 2303 extension study, showed rapid and powerful antiviral efficacy. In this case report, in agreement with data in literature, LdT showed rapid and efficacy reduction of HBV-DNA levels, persistent (>2 years) PCR negativity, ALT normalization, and HBsAg serum levels decline. Furthermore LdT did not demonstrate side effects and nephrotoxicity . AIM: To demonstrate the efficacy and safety of LdT to induce reduction of ALT serum levels, to promote a rapid HBV-DNA PCR negativization and a progressive reduction of quantitative HBsAg. METHODS: 52-years old Caucasian patient with naïve chronic hepatitis HBV-related (CHB) HBeAg negative. In 2004 patient has been diagnosed as HBV positive with increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels (1.5-2 × ULN). In December 2007 patient attended our Hepatology Unity for the first time. A complete clinical and virological evaluation was performed and then long-term suppressive treatment by Telbivudine (LdT) at the standard dose of 600 mg daily was started. On-treatment monitoring: ALT every month, HBV-DNA and HBsAg serum levels at week 12, 24 and 48 were performed. Follow-up monitoring: monthly ALT serum assay, HBV-DNA and HBsAg index every 3 months. RESULTS: Rapid virological suppression and HBV-DNA PCR negativity were achieved. Persistent PCR HBV-DNA negativity and progressive decline of HBsAg were recorded at week 72. CONCLUSIONS: Long-term suppressive treatment by Telbivudine has a rapid and powerful antiviral efficacy. Pharmakodynamic and kinetics of Ldt suggest that it may represent a viable therapeutic option for patients with CHB and it should now be granted a large space in the therapeutic landscape.
Telbivudine; HBsAg decline; Chronic hepatitis B
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/111129
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