Telbivudine: an effective anti-HBV drug for chronic hepatitis B patients with early on-treatment responses

Importance of the field: Hepatitis B virus (HBV) is a significant hepatocarcinogen. HBV replication is a major cause for the development of hepatocellular carcinoma (HCC). Past studies have documented that lamivudine (LAM) therapy deterred progression to cirrhosis and HCC. This risk reduction is attributed to effective viral suppression. There is a need for as many effective anti-HBV drugs as possible. Areas covered in this review: Telbivudine, the fourth FDA-approved oral antiviral drug, is highly potent for viral suppression for HBV. It is more potent than LAM and adefovir; its therapeutic response is superior to that of LAM in both HBeAg-positive and -negative patients, and it produces higher HBeAg seroconversion in patients with baseline ALT >= 2 times normal. Telbivudine has a resistance rate lower than that of LAM and higher than that of entecavir or tenofovir. What the reader will gain: There is a specific group of patients who are likely to achieve good therapeutic response with telbivudine. Take home message: Patients with low baseline HBV DNA combined with negative HBV DNA at week 24 obtain good therapeutic results with telbivudine. Therefore, selecting patients who meet the above conditions is important.