System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Review Ppublish

PubMed: 42358056 DOI: 10.1111/liv.70757

From Diagnosis to Durability: A Review of the European Bulevirtide Experience and Practical Learnings for CHD Management.

Liver Int 46(8):e70757

Authors: Monica Radu, Margarita Papatheodoridi, Habiba Kamal Khodir, Sabela Lens, Elisabetta Degasperi, Speranta Iacob, Liliana Gheorghe, Katja Steppich, Florin Alexandru Caruntu, Pietro Lampertico, Soo Aleman, Heiner Wedemeyer

Affiliations

  • National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania.
  • National and Kapodistrian University of Athens, Athens, Greece.
  • Institute for Liver and Digestive Health, University College London, London, UK.
  • Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Liver Unit, Hospital Clinic, University of Barcelona, FCRB-IDIBAPS, Barcelona, Spain.
  • Biomedical Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
  • Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Fundeni Clinical Institute, Bucharest, Romania.
  • HepNet Study-House, German Liver Foundation, Medizinische Hochschule Hannover (MHH), Hannover, Germany.
  • National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
  • Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.

Abstract

Hepatitis delta virus (HDV) infection causes chronic hepatitis D (CHD), the most severe form of chronic viral hepatitis with a high risk of progression to advanced liver disease. Off-label pegylated interferon alpha was the primary treatment option in Europe prior to the introduction of bulevirtide, a first-in-class HDV entry inhibitor. This review aimed to describe practical learnings around the management of CHD and strategies for supporting patients since bulevirtide 2 mg became the first approved treatment option in Europe. Since bulevirtide's approval, there has been an increased urgency to connect patients to care and real-world evidence has accumulated, underscoring the importance of reflex testing, increased awareness of HDV among doctors, and harmonization of universal screening guidelines in Europe to facilitate care for patients early in the disease course. Discussions with patients have shifted from preparing for disease progression to living with a long-term, daily treatment regimen, and clinical experience provides insight into best practices for navigating these conversations; it is critical for doctors to set evidence-based treatment expectations and provide ongoing guidance and support to patients. Real-world evidence demonstrates high treatment adherence and persistence; these studies and clinical trial data also indicate that long-term bulevirtide monotherapy is safe and effective, even in patients with compensated cirrhosis, may improve liver fibrosis measurements, and potentially reduce the risk of liver-related events and decompensation, which are important motivators for patients. Future research is needed to establish the safety and effectiveness of bulevirtide in certain special populations and determine the optimal treatment duration.

MeSH

Research Design, Disease Management, Hepatitis D, Hepatitis Delta Virus, Liver, Interferon-Alpha, Diagnosis, Therapeutics, Antiviral Agents, Hepatitis