The Efficacy of Add-on Telbivudine Versus Switching to Pegylated Interferon Alfa-2a in Chronic Hepatitis B Patients With Poor Responses to Adefovir.
BACKGROUND
There are limited options for chronic hepatitis B (CHB) patients who have poor responses to adefovir (ADV).


OBJECTIVE
The aim of this study is to evaluate the effects of adding on telbivudine (LdT) or switching to pegylated interferon alfa-2a (PEG-IFN-α2a) as alternative rescue therapies for patients with poor responses to the initial ADV treatments.


METHODS
Ninety-seven CHB patients with HBV DNA > 2 log10 copies/mL 48 weeks after ADV monotherapy were included in this study. Fifty-nine of these patients were treated with a combination of LdT plus ADV (LdT + ADV) daily, while thirty-eight patients were switched to PEG-IFN-α2a subcutaneous injections weekly for 48 weeks.


RESULTS
Both rescue strategies were proven to be safe and the majority of patients tolerated the therapies well. LdT + ADV led to more rapid reductions in viral loads than PEG-IFN-α2a monotherapy, with 2.14 (LdT + ADV) and 0.98 (PEG-IFN-α2a) log10 copies/mL decreases 48 weeks after rescue treatments, respectively (P < 0.00001). The rates corresponding to virological and biochemical responses were also elevated in patients who received the LdT + ADV combination therapy at the end of the observation period (88.1 vs. 68.4% for virological response, P = 0.017; 83.3 vs. 47.2%, P = 0.00045). However, the decline in the hepatitis B surface antigen (HBsAg) was more pronounced in PEG-IFN-α2a treated patients. Moreover, the cumulative rates of serological responses were higher in patients who switched to the PEG-IFN-α2a therapy.


CONCLUSIONS
Both add-on LdT and switching to PEG-IFN-α2a were satisfactory and optimal treatments for CHB patients with poor responses to ADV. Both rescue strategies resulted in significant reductions in serum viral load and ALT levels, and were associated with high rate of serological outcomes in our hospital.
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Xin
X
Wei
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Chao
C
Fan
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Yun
Y
Zhou
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Wenzhen
W
Kang
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Jiuping
J
Wang
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Li
L
Sun
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Linxu
L
Wang
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Meijuan
M
Peng
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Jianqi
J
Lian
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Zhansheng
Z
Jia
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Chunqiu
C
Hao
Adefovir; Biomarkers, Pharmacological; Drug Therapy; Hepatitis B, Chronic; Peginterferon Alfa-2a; Telbivudine