Clevudine is highly efficacious in hepatitis B e antigen‐negative chronic hepatitis B with durable off‐therapy viral suppression

• Published in: Hepatology (Baltimore, Md.) Vol. 46; no. 4; pp. 1041 - 1048
• Main Authors: Yoo, Byung Chul, Kim, Ju Hyun, Kim, Tae‐Hun, Koh, Kwang Cheol, Um, Soon‐Ho, Kim, Young Soo, Lee, Kwan Sik, Han, Byung Hoon, Chon, Chae Yoon, Han, Joon‐Yeol, Ryu, Soo Hyung, Kim, Haak Cheoul, Byun, Kwan Soo, Hwang, Seong Gyu, Kim, Byung‐Ik, Cho, Mong, Yoo, Kwon, Lee, Heon‐Ju, Hwang, Jae Seok, Kim, Yun Soo, Lee, Young‐Suk, Choi, Sung‐Kyu, Lee, Youn‐Jae, Yang, Jin‐Mo, Park, Joong‐Won, Lee, Myung‐Seok, Kim, Dae‐Ghon, Chung, Young‐Hwa, Cho, Se‐Hyun, Choi, Jong‐Young, Kweon, Young‐Oh, Lee, Heon Young, Jeong, Sook‐Hyang, Yoo, Hee‐Won, Lee, Hyo‐Suk
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-10-2007; Wiley
• Subjects: Adolescent; Adult; Alanine Transaminase - blood; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - pharmacology; Antiviral Agents - therapeutic use; Arabinofuranosyluracil - adverse effects; Arabinofuranosyluracil - analogs & derivatives; Arabinofuranosyluracil - pharmacology; Arabinofuranosyluracil - therapeutic use; Biological and medical sciences; DNA, Viral - blood; Dose-Response Relationship, Drug; Double-Blind Method; Drug Resistance, Viral; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genotype; Hepatitis B e Antigens - blood; Hepatitis B virus - drug effects; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - immunology; Human viral diseases; Humans; Infectious diseases; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Time Factors; Viral diseases; Viral hepatitis; Human; Toxicity; Hepatic disease; Epidemiology; Clevudine; Incidence; Infection; Hepatitis B e antigen; Viral hepatitis B; Polymerase chain reaction; Treatment; Viral disease; Gastroenterology; Nucleoside analog; Digestive diseases; Antiviral; Molecular biology; Pyrimidine nucleoside; Viral hepatitis E
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.21800

Clevudine is a pyrimidine analog with potent and sustained antiviral activity against HBV. In the present study, we evaluated the safety and efficacy of clevudine 30 mg daily for 24 weeks and assessed the durability of antiviral response for 24 weeks after cessation of dosing in hepatitis B e antigen (HBeAg)‐negative chronic hepatitis B (e‐CHB). We randomized a total of 86 patients (3:1) to receive clevudine 30 mg (n = 63) or placebo (n = 23) daily for 24 weeks. We followed patients for an additional 24 weeks after withdrawal of treatment. The median changes in HBV DNA from baseline were −4.25 and −0.48 log10 copies/mL at week 24 in the clevudine and placebo groups, respectively (P < 0.0001). Viral suppression in the clevudine group was sustained after withdrawal of therapy, with 3.11 log10 reduction at week 48. At week 24 and week 48, 92.1% and 16.4% of patients in the clevudine group had undetectable serum HBV DNA levels by Amplicor PCR assay (<300 copies/mL). The proportion of patients who achieved ALT normalization was 74.6% and 33.3% in the clevudine and placebo groups at week 24, respectively (P = 0.0006). ALT normalization in the clevudine group was well‐maintained during the post‐treatment follow‐up period. The incidence of adverse events was similar in the 2 groups. No resistance to clevudine was detected during treatment. Conclusion: A 24‐week clevudine therapy was well‐tolerated and showed potent and sustained antiviral effect without evidence of viral resistance in e‐CHB patients. However, treatment for longer than 24 weeks would be needed to achieve durable remission. (HEPATOLOGY 2007.)