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Telbivudine: a hepatitis B-specific antiviral

Telbivudine, a l-nucleoside enantiomer, is a potent specific inhibitor of hepatitis B virus (HBV) polymerase. It recently completed Phase III trials and has been licensed in most countries worldwide. It has shown superior efficacy compared with lamivudine in therapeutic response, reduction in HBV DNA, proportion of patients with undetectable HBV DNA, reduced primary treatment failure and reduced viral resistance over 2 years, in Hepatitis B e antigen-positive and -negative patients. Further studies show that switching to telbivudine in lamivudine-suboptimal responders improves the reduction in HBV DNA at week 24 and shows superiority compared with adefovir in reduction of HBV DNA at week 24. Multivariate analysis showed that week 24 HBV DNA best predicted outcomes at 2 years and a ‘hepatitis B roadmap’ concept has been proposed to manage patients based on this. Thus, telbivudine is a useful addition to the current landscape of hepatitis B therapeutic agents.