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Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors.

Min-Yu Lan1,2,3, Hui-Chen Lin1, Tsung-Hui Hu4

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Telbivudine treatment for chronic hepatitis B can cause myopathy, characterized by mitochondrial defects. Impaired kidney function and HBeAg positivity are key risk factors for this muscle-related side effect.

Keywords:
chronic hepatitis Bhepatitis B e antigenmitochondriamyopathytelbivudine

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Area of Science:

  • Hepatology
  • Pharmacology
  • Pathology

Background:

  • Oral nucleos(t)ide analogs (NAs) are primary treatments for chronic hepatitis B (CHB).
  • Myotoxicity is a known extrahepatic complication of NA therapy.
  • Telbivudine is an NA frequently linked to muscle-related side effects, but risk factors for telbivudine-induced myopathy (TIM) remain unclear.

Purpose of the Study:

  • To characterize the clinical, MRI, and pathological features of telbivudine-induced myopathy (TIM).
  • To identify risk factors associated with TIM in patients with chronic hepatitis B (CHB).

Main Methods:

  • Detailed analysis of 12 TIM cases, including clinical, MRI, and muscle pathology.
  • Comparison of demographic and clinical factors between TIM patients and telbivudine-tolerant (TT) CHB controls.
  • Logistic regression analysis to determine factors independently associated with TIM.

Main Results:

  • TIM developed after a median of 19.5 months of telbivudine use.
  • Muscle histopathology showed mitochondrial abnormalities (proliferation, accumulation, defects).
  • TIM patients had lower estimated glomerular filtration rate and higher HBeAg positivity compared to TT controls.

Conclusions:

  • Mitochondrial abnormalities are key pathological findings in TIM.
  • Impaired renal function and HBeAg positivity are significant risk factors for TIM.
  • Telbivudine-induced mitochondrial dysfunction and immune activation may cause TIM; clinical surveillance is crucial.