Clinical and Molecular Hepatology

Correspondence to editorial on “Human cytomegalovirus reactivation in cirrhosis patients with acute decompensation”: Changze Hong, Jinjun Chen; Clin Mol Hepatol 2026;32(2):e227-e230.
Published online August 25, 2025; DOI: https://doi.org/10.3350/cmh.2025.0899

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Viral hepatitis

Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B: Eun Hye Kim, Hana Park, Kun Ho Lee, Sang Hoon Ahn, Seung-Min Kim, Kwang-Hyub Han; Korean J Hepatol 2013;19(1):82-86.
Published online March 25, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.1.82

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Telbivudine is an L-nucleoside analogue with potent antiviral activity against hepatitis B virus (HBV). Clinical trials have shown that telbivudine has a more potent and sustained antiviral activity with a lower frequency of viral resistance than lamivudine. Although there are several reports concerning the safety profile of telbivudine, most adverse events are described as mild and transient in nature. Here we report two cases of telbivudine-induced myopathy in patients with chronic hepatitis B who were siblings.

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Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors
Min-Yu Lan, Hui-Chen Lin, Tsung-Hui Hu, Shu-Fang Chen, Chien-Hung Chen, Yung-Yee Chang, King-Wah Chiu, Tsu-Kung Lin, Shun-Sheng Chen
Journal of Clinical Neurology.2023; 19(1): 52. CrossRef
Telbivudine for renal transplant recipients with chronic hepatitis B infection: a randomized controlled trial with early termination
Ya-Wen Yang, Meng-Kun Tsai, Ching-Yao Yang, Chih-Yuan Lee, Bor-Luen Chiang, Hong-Shiee Lai
Clinical and Experimental Nephrology.2020; 24(5): 474. CrossRef
Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop
Hyung Joon Yim, Ji Hoon Kim, Jun Yong Park, Eileen L. Yoon, Hana Park, Jung Hyun Kwon, Dong Hyun Sinn, Sae Hwan Lee, Jeong-Hoon Lee, Hyun Woong Lee
Clinical and Molecular Hepatology.2020; 26(4): 411. CrossRef
Telbivudine-Induced Myopathy Incidentally Detected by FDG PET/CT Imaging in a Patient With History of Hepatocellular Carcinoma
Sijuan Zou, Zhaoting Cheng, Shuang Song, Dongling Zhu, Xiaohua Zhu
Clinical Nuclear Medicine.2019; 44(2): 171. CrossRef
Mitochondrial myopathies caused by prolonged use of telbivudine
Jong-Mok Lee, Jin-Hong Shin, Young-Eun Park, Dae-Seong Kim
Annals of Clinical Neurophysiology.2017; 19(1): 40. CrossRef
Chronic Hepatitis B: A Critical Discussion
Jianfei Long, Min Wang, Bicui Chen, Jiming Zhang, Bin Wang
Future Virology.2017; 12(3): 111. CrossRef
The Ca 2+ /CaMKK2 axis mediates the telbivudine induced upregulation of creatine kinase: Implications for mechanism of antiviral nucleoside analogs’ side effect
Long Jianfei, Wang Min, Ma Chunlai, Chen Bicui, Zhang Jiming, Wang Bin
Biochemical Pharmacology.2017; 146: 224. CrossRef
Rhabdomyolysis, lactic acidosis, and multiple organ failure during telbivudine treatment for hepatitis B: a case report and review of the literature
Jinxin Zheng, Minggui Deng, Xiaoliang Qiu, Zhong Chen, Duoyun Li, Xiangbin Deng, Qiwen Deng, Zhijian Yu
Journal of Medical Case Reports.2017;[Epub] CrossRef
Cumulative incidence and risk factors of creatine kinase elevation associated with telbivudine
Li Chen, Cai Cheng, Bicui Chen, Yue Zhao, Jiming Zhang, Bin Wang
European Journal of Clinical Pharmacology.2016; 72(2): 235. CrossRef
Clinicopathological Features of Telbivudine-Associated Myopathy
Tomica Ambang, Joo-San Tan, Sheila Ong, Kum-Thong Wong, Khean-Jin Goh, Jose Ignacio Herrero
PLOS ONE.2016; 11(9): e0162760. CrossRef

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A case of sudden-onset hearing Loss in a patient treated with peginterferon α-2b and ribavirin for chronic hepatitis C: Min Ki Shin , Tae Hyo Kim , Kang Ju , Chang Yoon Ha , Hyun Ju Min , Woon Tae Jung , Ok Jae Lee; Korean J Hepatol 2009;15(3):370-374.
Published online September 30, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.3.370

Abstract
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Combination therapy of pegylated interferon α and ribavirin has been associated with various adverse effects, but sudden-onset hearing loss is uncommon. We report a 60-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon α and ribavirin for chronic hepatitis C. This patient had been diagnosed with chronic hepatitis C (genotype Ib) and early-stage liver cirrhosis 3 years previously, and had been treated with conventional interferon-α and ribavirin for 12 months. However, 6 months from the end of the treatment course the patient relapsed and received combination retreatment with pegylated interferon α-2b and ribavirin. He developed sudden-onset right-side hearing loss and tinnitus 42 weeks after the start of this retreatment. Pure-tone audiometry revealed a right-side hearing loss of 60~90dB. The patient consequently immediately discontinued the pegylated interferon therapy and was given prednisone 60 mg/day for 10 days, after which the hearing loss had almost completely recovered. (Korean J Hepatol 2009;15:370-374)

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A Narrative Review of Pharmacologic Treatments for COVID‐19: Safety Considerations and Ototoxicity
Christine Little, Maura K. Cosetti
The Laryngoscope.2021; 131(7): 1626. CrossRef
Cochlear Changes Caused by Peginterferon α-2b
Reham F. Zittoon, Yasser T. Madian, Diaa Eldeen M. Alhennawi, Hany S. Nadeem
Journal of Interferon & Cytokine Research.2018; 38(7): 311. CrossRef
Unilateral hearing loss due to pegylated interferon-α2b and ribavirin therapy
Savita Jain, Vandana Midha, Ajit Sood
Indian Journal of Gastroenterology.2011; 30(5): 239. CrossRef

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Development of ocular myasthenia during pegylated interferon and ribavirin treatment for chronic hepatitis C: Hyung Min Kang, M.D., Myung Jin Park, M.D.1, Jeong-Min Hwang, M.D.1, Jin Wook Kim, M.D., Sook-Hyang Jeong, M.D.; Korean J Hepatol 2009;15(2):209-215.
Published online June 30, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.2.209

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A 63-year-old male experienced sudden diplopia after 9 weeks of administration of pegylated interferon (IFN) α-2b and ribavirin for chronic hepatitis C (CHC). Ophthalmologic examinations showed ptosis on the right upper lid and restricted right eye movement without any other neurological signs. A brain imaging study and repetitive nerve stimulation test indicated no abnormality. The acetylcholine receptor antibody titer and response to acetylcholinesterase inhibitors were negative, and the results of thyroid function tests were normal. The patient’s ophthalmological symptoms improved rapidly 3 weeks after discontinuation of pegylated IFN α -2b and ribavirin. The ocular myasthenia associated with combination therapy of pegylated IFN α-2b and ribavirin for CHC is very rarely reported; therefore, we present this case with a review of the various eye complications of IFN therapy. (Korean J Hepatol 2009;15:209-215)

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Autoimmune Neuromuscular Diseases Induced by Immunomodulating Drugs
Songkit Supakornnumporn, Bashar Katirji
Journal of Clinical Neuromuscular Disease.2018; 20(1): 28. CrossRef
Myasthenia Crisis Induced by Pegylated-Interferon in Patient With Chronic Hepatitis C
Su Jung Baik, Tae Hun Kim, Hye In Kim, Jeong Yeon Rhie
Medicine.2016; 95(21): e3782. CrossRef
Pegylated Interferon Induced Myasthenia Crisis—A Case Report
Jonathan P. Congeni, Robert B. Kirkpatrick
Journal of Clinical Neuromuscular Disease.2013; 14(3): 123. CrossRef

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Efficacy of initial treatment with peginterferon alpha-2a versus peginterferon alpha-2b in combination with ribavirin in naive chronic hepatitis C patients Living in Daejeon and Chungcheong Province in Korea: A comparative study: Jeong Il Kim, M.D, Seok Hyun Kim, M.D., Byung Seok Lee, M.D., Heon Young Lee, M.D., Tae Hee Lee, M.D.1, Young Woo Kang, M.D.1, Hyang Ie Lee, M.D.2, An Na Kim, M.D.2, Soon Woo Nam, M.D.3, Byeong Chool Park, M.D.4, Hee Bok Chae, M.D.4, Seok Bae Kim, M.D.5, Il Han Song, M.D.5, Ji Young Park, M.D.6, Hong Su Kim, M.D.6; Korean J Hepatol 2008;14(4):493-502.
Published online December 31, 2008; DOI: https://doi.org/10.3350/kjhep.2008.14.4.493

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Backgrounds/Aims
Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. Methods: Ninety-seven patients were treated with peginterferon alpha-2a (180 ?g/week, n=48) or peginterferon alpha-2b(1.5 ?g/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. Results: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peg-interferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. Conclusions: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients. (Korean J Hepatol 2008;14:493-502)

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Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients
Hyun Seok Lee, Young Oh Kweon, Won Young Tak, Soo Young Park, Eun Jung Kang, Yu Lim Lee, Hae Min Yang, Hyun Woo Park
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Role of Interleukin 28B-related Gene Polymorphisms in Chronic Hepatitis C and the Response to Antiviral Therapy in Koreans
Young Kul Jung, Ji Hoon Kim, Sung-Min Ahn, Jae Won Yang, Sang Jin Park, Jong Woo Kim, Jong Eun Yeon, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim, Kwan Soo Byun
Journal of Clinical Gastroenterology.2013; 47(7): 644. CrossRef
Pegylated Interferon-α2a and Ribavirin versus Pegylated Interferon-α2b and Ribavirin in Chronic Hepatitis C
Nicolas Flori, Natalie Funakoshi, Yohan Duny, Jean-Christophe Valats, Michael Bismuth, Dimitri Christophorou, Jean-Pierre Daurès, Pierre Blanc
Drugs.2013; 73(3): 263. CrossRef
Efficacy of Peginterferon and Ribavirin Combination Therapy of Chronic Hepatitis C: A Pooled Analysis
Soo Yong Park, Min Young Rim, In Ku Yo, Min Su Ha, Ju Seung Kim, Ji Won Lee, Young Kul Jung, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim
The Korean Journal of Gastroenterology.2012; 60(5): 306. CrossRef
Efficacy of peginterferon and ribavirin is associated with the IL28B gene in Korean patients with chronic hepatitis C
Seok Hoo Jeong, Young Kul Jung, Jae Won Yang, Sang Jin Park, Jong Woo Kim, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Ju Hyun Kim
Clinical and Molecular Hepatology.2012; 18(4): 360. CrossRef
Recent trends in the treatment of chronic hepatitis C
Dae Won Jun, Won Young Tak, Si Hyun Bae, Youn Jae Lee
The Korean Journal of Hepatology.2012; 18(1): 22. CrossRef
Peginterferon alpha and ribavirin combination therapy in patients with hepatitis C virus-related liver cirrhosis
Kyung Hoon Kim, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Young Oh Kweon, Won Young Tak, Heon Ju Lee, Chang Hyeong Lee, Jeong Ill Suh
The Korean Journal of Hepatology.2011; 17(3): 220. CrossRef
Current status of liver disease in Korea: Hepatitis C
Young-Suk Lim
The Korean Journal of Hepatology.2009; 15(Suppl 6): S25. CrossRef
Treatment of chronic hepatitis C: Efficacy of initial treatment of peginterferon alpha-2a versus peginterferon alpha-2b plus ribavirin in naive chronic hepatitis C patients
Youn Jae Lee
The Korean Journal of Hepatology.2008; 14(4): 443. CrossRef

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Pulmonary Toxicity by Pegylated Interferon α-2a in a Patient with Chronic Hepatitis C: Byoung Kwan Son , Joo Hyun Sohn , Tae Yeob Kim , Yoon Kyung Park , Yong Chul Jeon , Dong Soo Han; Korean J Hepatol 2007;13(1):103-107.

Abstract
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The combination therapy with pegylated interferon α and ribavirin has increasingly prescribed for chronic hepatitis C. Although many side effects of interferon such as flu-like symptoms, gastrointestinal and neuropsychiatric symptoms are well known, only several cases of interferon-induced pulmonary toxicity have been reported. Interferon-induced pulmonary toxicity usually develops from 2 weeks to 12 weeks after treatment for HCV infection. Diagnosis is commonly based on clinical findings such as a dry cough, dyspnea, hypoxemia, and a restrictive pattern in pulmonary function testing, bilateral diffuse parenchymal infiltrations, histopathological findings of interstitial pneumonitis, and exclusion of any other causative agents. Prompt withdrawal of the drug is the cornerstone of treatment. We report a case of PEG-IFN α-2a induced pulmonary toxicity in a 50-year-old male patient with hepatitis C. To our knowledge, this is the first case of pegylated interferon α-2a induced pulmonary toxicity in Korea. (Korean J Hepatol 2007;13:103-107)