Abstract: Objective To evaluate the therapeutic efficacy of telbivudine (LDT) in hepatitis B e antigen (HBeAg) -positive chronic hepatitis B (CHB) patients with high baseline alanine aminotransferase (ALT) levels.Methods A total of 60 HBeAg-positive CHB patients were allocated to the higher baseline ALT group with ALT between 10 and 20 times the upper limit of normal and the lower baseline ALT group with ALT between 2 and 10 times the upper limit of normal according to the ALT level, and all patients were given LDT 600 mg daily as initial antiviral treatment for at least 52 weeks.We compared the response profiles between the two groups at 52 week.Results By week 52, the mean hepatitis B virus (HBV) DNA level decreased significantly in the higher baseline ALT group than the lower baseline ALT group, and there was significant difference;furthermore, there was respectively significant difference in the HBeAg-negativity HBeAg seroconversion, HBsAg-negativity between the two groups;moreover, 4 cases became hepatitis B surface antigen (HBsAg) -negative and 3 had HBsAg seroconversion in the higher baseline group.None in the lower baseline group became HBsAg-negative and seroconversion.The ALT normalization rate, viral breakthrough, genotypic resistance to LDT, and elevations in creatine kinase levels were similar in the two groups over the 52 week.Conclusion Higher baseline ALT level is a strong predictor for optimal efficacy with LDT treatment.