2 The technology

2.1 Telbivudine (Sebivo, Novartis) is a synthetic thymidine nucleoside analogue. It works by inhibiting the viral DNA polymerase responsible for viral replication. Telbivudine is licensed for the treatment of chronic hepatitis B in adults with compensated liver disease and evidence of viral replication, persistently elevated serum alanine aminotransferase (ALT) levels and histological evidence of active inflammation and/or fibrosis.

2.2 The most common side effects associated with telbivudine include dizziness, headache, cough, diarrhoea, nausea, abdominal pain, rash, fatigue and increased levels of blood creatine phosphokinase, ALT and amylase. Uncommon side effects include malaise, arthralgia, myalgia, peripheral neuropathy and myopathy. For full details of side effects and contraindications, see the summary of product characteristics (SPC).

2.3 The recommended dose of telbivudine is 600 mg (one tablet) once daily, taken orally, with or without food. The optimal treatment duration is unknown (see the SPC for criteria for treatment discontinuation). Telbivudine costs £290.33 for 28 × 600-mg tablets (excluding VAT; 'British national formulary' edition 55). Costs may vary in different settings because of negotiated procurement discounts.