Treatment of Chronic Hepatitis D with Bulevirtide-A Fight against Two Foes-An Update

HDV infection frequently causes progression to cirrhosis and hepatocellular carcinoma (HCC). In summer 2020, the first potentially effective drug Bulevirtide (BLV) has been approved for the treatment of HDV by the EMA. BLV is a synthetic N-acylated pre-S1 lipopeptide that blocks the binding of HBsAg-enveloped particles to the sodium taurocholate co-transporting polypeptide (NTCP), which is the cell entry receptor for both HBV and HDV. In this review, we discuss the available data from the ongoing clinical trials and from real world series. Clinical trials and real-world experiences demonstrated that BLV 2 mg administered for 24 or 48 weeks as monotherapy or combined with pegIFN alpha reduces HDV viremia and normalizes ALT levels in a large proportion of patients. The combination of BLV and pegIFN alpha shows a synergistic on-treatment effect compared with either one of the monotherapies.

Automated summary

Bulevirtide is a potential effective drug for the treatment of HDV infection by blocking the entry of HBV and HDV into cells. Clinical trials and real-world experiences have shown that the use of BLV alone or in combination with pegIFN alpha can effectively reduce HDV viremia and normalize ALT levels in patients.