ArticleJHEP reports : innovation in hepatology2026
Response-guided bulevirtide ± pegylated interferon alfa-2a: Long-term outcomes observed in the nationwide Austrian hepatitis D cohort study.
Article in JHEP reports : innovation in hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- From Diagnosis to Durability: A Review of the European Bulevirtide Experience and Practical Learnings for CHD Management.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
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Authors and funding
23 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsChronic hepatitis D (CHD) often progresses to advanced chronic liver disease (ACLD). Bulevirtide (BLV) is approved for CHD, yet treatment duration, management of suboptimal response, and the potential for finite treatment remain unclear.
methodsPatients receiving BLV at 10 Austrian centers were included. Virological, biochemical, and combined response (VR/BR/CR) were assessed every 6 months (M6-M24). Pegylated interferon alfa-2a (PegIFN) was offered to suboptimal responders.
resultsSixty-one patients (median age: 45 years, 60.7% men, ACLD: 68.9%) receiving BLV for a median of 29.0 months were included. VR (Month [M]6: 36.4%, M12: 64.2%, M24: 61.9%), BR (M6: 56.4%, M12: 69.8%, M24: 66.7%), and CR (M6: 25.5%, M12: 47.2%, M24: 42.9%) were maintained for 2 years. Liver stiffness and systemic inflammation (i.e. C-reactive protein [CRP] and procalcitonin [PCT]) decreased under BLV treatment (all p <0.01). Nineteen patients (31.1%) received add-on PegIFN to BLV monotherapy after a median of 10.5 months, inducing a further HDV-RNA decline by 1.65 (IQR 0.81-2.11) log
conclusionsHigh response rates to BLV were observed in this nationwide cohort. In suboptimal BLV responders, PegIFN add-on was associated with a significant and partly sustained decline in HDV-RNA and HBsAg, indicating a relevant contribution to long-term viral infection control. Sustained negative HDV-RNA could help identify candidates for finite BLV treatment. IMPACT AND IMPLICATIONS: CHD is a severe form of viral hepatitis with rapid progression to cirrhosis and hepatocellular carcinoma, highlighting the need for effective treatments. In this real-world cohort of 61 Austrian patients, BLV significantly reduced HDV-RNA, alanine aminotransferase, and liver stiffness (p <0.001). Add-on PegIFN resulted in a further decline of HDV-RNA and HBsAg by 24 weeks of combined treatment (p <0.01) in 19 patients with suboptimal response to BLV treatment, and long-term HDV-RNA TND allowed elective treatment discontinuation in 10 patients under close surveillance.
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