The effects of telbivudine in late pregnancy to prevent intrauterine transmission of the hepatitis B virus: a systematic review and meta-analysis
Open Access
- 4 September 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Virology Journal
- Vol. 9 (1), 185
- https://doi.org/10.1186/1743-422x-9-185
Abstract
Chronic hepatitis B virus (HBV) infection poses a serious public health problem in many parts of the world. Presently, even with proper joint immunoprophylaxis, approximately 10-15% of newborns from HBV carrier mothers suffer from HBV infection through intrauterine transmission. One of the risk factors is the level of maternal viraemia. Telbivudine is a synthetic thymidine nucleoside analogue with activity against HBV. A few studies have evaluated the efficacy of telbivudine in preventing intrauterine HBV infection during late pregnancy. So we conducted this meta-analysis to arrive at an evidence-based conclusion. We searched Medline/PubMed, EMBASE, Cochrane Library, Web of Knowledge and China Biological Medicine Database from January 1990 to December 2011. Relative risks (RR) of the seropositivity rates for hepatitis B surface antigen (HBsAg) and HBV DNA in newborns and infants were studied. Mean differences (MD) in maternal HBV DNA levels were reviewed. Finally two randomised controlled trials (RCTs) and four non-randomised controlled trials (NRCTs) were left for analysis which included 576 mothers in total, of whom 306 received telbivudine treatment and 270 did not receive any drug. All newborns received hepatitis B vaccine (HBVac) and hepatitis B immunoglobulin (HBIG) after birth. The seropositivity rate for HBsAg or HBV DNA was significantly lower in the telbivudine group, both at birth and at 6–12 months follow up. Meanwhile, maternal HBV DNA levels prior to delivery were significantly lower in the telbivudine group. In addition, the frequency of serum creatine kinase (CK) elevation was similar in the two groups. Our meta-analysis provides preliminary evidence that telbivudine application in late pregnancy is effective in the interruption of intrauterine HBV infection, with no significant adverse effects or complications. More high quality, well-designed, double-blinded, randomised controlled and large size clinical trials are needed for further investigation and more convincing results in the future.Keywords
This publication has 33 references indexed in Scilit:
- Analysis of prognosis‐associated factors in fulminant viral hepatitis during pregnancy in ChinaInternational Journal of Gynecology & Obstetrics, 2011
- Lamivudine in Late Pregnancy to Interrupt In Utero Transmission of Hepatitis B VirusObstetrics & Gynecology, 2010
- TelbivudineNature Reviews Drug Discovery, 2007
- Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysisBMJ, 2006
- Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infectionWorld Journal of Gastroenterology, 2004
- Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infectionJournal of Viral Hepatitis, 2003
- Vertical transmission of hepatitis B virus despite maternal lamivudine therapyThe Lancet, 2002
- Ten-year neonatal hepatitis B vaccination program, the Netherlands, 1982–1992: protective efficacy and long-term immunogenicityVaccine, 1997
- Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areasrEpidemiology and Infection, 1996
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986