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REVIEW Open AccessComparison of the efficacy of lamivudine andtelbivudine in the treatment of chronic hepatitisB: a systematic reviewShushan Zhao 1* , Lanhua Tang 1 , Xuegong Fan 1* , Lizhang Chen 1,2 , Rongrong Zhou 1 , Xiahong Dai 1AbstractBackground: Chronic viral hepatitis B remains a global public health concern. Currently, several drugs, such aslamivudine and telbivudine, are recommended for treatment of patients with chronic hepatitis B. However, thereare no conclusive results on the comparison of the efficacy of lamivudine (LAM) and telbivudine (LdT) in thetreatment of chronic hepatitis B.Results: To evaluate the comparison of the efficacy of LAM and LdT in the treatment of chronic hepatitis B by asystematic review and meta-analysis of clinical trials, we searched PUBMED (from 1990 to April 2010), Web ofScience (from 1990 to April 2010), EMBASE (from 1990 to April 2010), CNKI (National Knowledge Infrastructure)(from 1990 to April 2010), VIP database (from 1990 to April 2010), WANFANG database (from 1990 to April 2010),the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Review. At the end ofone-year treatment, LdT was better than LAM at the biochemical response, virological response, HBeAg loss,therapeutic response, while less than at the viral breakthrough and viral resistance, but there was no significantdifference in the HBeAg seroconversion and HBsAg response. LdT was better than LAM at the HBeAgseroconversion with prolonged treatment to two years.Conclusions: In summary, LdT was superior in inhibiting HBV replication and preventing drug resistance ascompared to LAM for CHB patients. But LdT may cause more nonspecific adverse events and can lead to more CKelevation than LAM. It is thus recommended that the LdT could be used as an option for patients but adverseevents, for example CK elevation, must be monitored.BackgroundChronic hepatitis B virus (HBV) infection is a seriousglobal public health problem associated with cirrhosis,liver failure and hepatocellular carcinoma (HCC) [1]. Ofthe two billion people who have been infected, morethan 350 million have chronic hepatitis[2]. It is esti-mated that between 235,000 and 328,000 people dieannually due to liver cirrhosis and hepatocellular carci-noma, respectively[3]. Currently, several drugs arerecommended for treatment of patients with chronichepatitis B. These drugs can be divided into two maingroups based on their mechanism of action, namelyimmunomodulatory drugs like alpha interferons andanti-viral drugs including lamivudine, adefovir, entecavir,tenofovir, and telbivudine[4].LdT was approved by the US Food and Drug Admin-istration (FDA) on October 25, 2006. It is an L-nucleo-side that is structurally related to lamivudine and highlyselective for hepatitis B virus DNA and inhibits viralDNA synthesis with no effect on human DNA or otherviruses[5]. In the woodchuck model of HBV infection,viral replication was inhibited within the first few daysof treatment and was maintained throughout the treat-ment period. Then viral rebound with pretreatmentlevels between week 4 and week 8[5]. A placebo-con-trolled dose-escalation trial investigated daily dosinglevels of LdT between 25 and 800 mg/day for 4 weeks.This study showed that LdT induced striking dose-related suppression of serum HBV DNA levels and anearly maximal viral load reduction was obtained at* Correspondence: zhaoshuiquan@gmail.com; xgfan@hotmail.com1 Department of Infectious Diseases, Xiangya Hospital, Central SouthUniversity, Changsha, ChinaFull list of author information is available at the end of the articleZhao et al. Virology Journal 2010, 7:211http://www.virologyj.com/content/7/1/211© 2010 Zhao et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.