Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus

• DOI: 10.1111/jgh.13436
• Publication Date: 2016-05-10T00:16:52Z
• Authors: Jinfeng Liu; Jing Wang; Dongfang Jin; Caijing Qi; TaoTao Yan; Furong Cao; Li Jin; Zhen Tian; Dandan Guo; Ningxia Yuan; Weihong Feng; Shulin Zhang; Yingren Zhao; Tianyan Chen
• Keywords: Adult; 0303 health sciences; Telbivudine; Postpartum Period; Alanine Transaminase; Antiviral Agents; Drug Administration Schedule; Infectious Disease Transmission, Vertical; 3. Good health; Young Adult; 03 medical and health sciences; Hepatitis B, Chronic; Pregnancy; Humans; Female; Hepatitis B e Antigens; Pregnancy Complications, Infectious; Follow-Up Studies; Thymidine

AbstractBackground and AimThe efficacy of telbivudine for breaking vertical transmission of hepatitis B virus has been well established. Data on the risk of postpartum flare after telbivudine withdrawal and efficacy of extended antiviral therapy after delivery are limited.MethodsChronic hepatitis B virus‐infected women who received telbivudine beginning at week 24 or 28 of gestation were enrolled and then followed up to 52 weeks postpartum. Virological and biochemical parameters were assessed.ResultsOf the 241 women who finished 52 weeks of follow‐up, 33.6% had elevated serum alanine aminotransferase (ALT) during pregnancy. Telbivudine administration resulted in ALT normalization in 85.2% before delivery. Compared with women having a normal ALT level throughout pregnancy, those with elevated ALT had a significantly higher rate of ALT flare after telbivudine withdrawal (25.0%vs11.9%;χ2 = 4.273,P = 0.039). Multivariate analysis indicated that only ALT elevation during pregnancy correlated with postpartum flare after telbivudine withdrawal. Those women with elevated ALT during pregnancy continued antiviral treatment to 52 weeks postpartum and had a significantly higher HBeAg seroconversion rate (P = 0.001) and a notable decrease in HBsAg titers (P = 0.001).ConclusionIt is safe for the majority of women to withdraw telbivudine after delivery, whereas exciting serological response encourages extended antiviral therapy for mother with ALT elevation during pregnancy.