The long-term effects of
telbivudine (TBV) on decompensated hepatitis B virus (HBV)-related
cirrhosis were still not established. This study aimed to investigate the efficacy and safety of TBV in such cohort of patients as compared to
lamivudine (
LAM) and
entecavir (ETV). We retrospectively evaluated 130 treatment-naïve patients with HBV-related decompensated
cirrhosis who started treatment with TBV (n = 31),
LAM (n = 45) or ETV (n = 54). After 24 months of treatment, cumulative virological response (VR) rates (HBV
DNA <500 copies/mL) were 83.7, 65.3 and 89.1 % in TBV,
LAM and ETV groups, respectively (p = 0.009). Reduction in HBV
DNA levels in TBV was -3.66 ± 0.56, significantly higher than
LAM (-3.34 ± 0.59; p < 0.05) and lower than ETV group (-3.98 ± 0.52; p < 0.05). The rates of
HBeAg loss or seroconversion and normalization of
alanine aminotransferase (ALT) were similar among the groups. Child-Turcotte-Pugh (
CTP) score and model for
end-stage liver disease score in TBV were significantly improved compared to at baseline without difference among the groups. TBV resulted in similar cumulative rates of survival and incidence of
hepatocellular carcinoma (HCC) to
LAM and ETV. Frequencies of complications from
cirrhosis, including variceal
bleeding,
hepatic encephalopathy and spontaneous bacterial
peritonitis, were comparable among the groups. Four patients (16.7 %) in TBV displayed virological breakthrough, lower than
LAM and higher than ETV (p = 0.004). Cox regression analysis showed that baseline HBV
DNA (hazard ratio 0.743; 95 % confidence interval 0.582-949, p = 0.017) was an independent predictor for VR at 24 months. Long-term
therapy with TBV was effective and safe in HBV-related decompensated
cirrhosis.