Is telbivudine superior to lamivudine for the treatment of patients with chronic hepatitis B?

Abstract

This practice point commentary discusses the findings and limitations of a prospective, double-blind, phase III trial conducted by Lai et al. in which patients with chronic hepatitis B (CHB) were randomly allocated to receive telbivudine 600 mg daily or lamivudine 100 mg daily. The trial showed that telbivudine was superior to lamivudine in terms of mean reduction in number of HBV DNA copies/ml from baseline, the number of patients with a reduction in serum HBV DNA to undetectable levels, and rate of HBV drug resistance. This commentary highlights the issues to consider when interpreting and generalizing these results, including the fact that lamivudine is no longer recommended as first-line therapy for patients with CHB and that head-to-head comparisons between telbivudine and its two alternatives—entecavir and adefovir dipivoxil—have not been performed. The importance of selecting patients for treatment according to predictive factors of a good response is also highlighted.