Response-guided bulevirtide ± pegylated interferon alfa-2a: Long-term outcomes observed in the nationwide Austrian hepatitis D cohort study

作者：Michael Schwarz, Marlene Hintersteininger, Caroline Schwarz, Marlene Panzer, Nikolaus Pfisterer, Nina Loschko, Lukas Hartl, Livia Dorn, Hermann Laferl, Michael Trauner, F. Stättermayer Albert, Mattias Mandorfer, Ivo Graziadei, Andreas Maieron, Alexander R. Moschen, Elmar Aigner, Vanessa Stadlbauer, Christian Madl, W. Aberle Stephan, Heinz Zoller, Michael Gschwantler, Thomas Reiberger, Mathias Jachs · 发表于：JHEP Reports · 年份：2026 · DOI：10.1016/j.jhepr.2026.101835 · 被引用次数：3 · 研究领域：Hepatitis C virus research、Hepatitis B Virus Studies、Hepatitis Viruses Studies and Epidemiology

Background & Aims Chronic 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. Methods Patients receiving BLV at ten Austrian centers were included. Virological, biochemical, and combined response (VR/BR/CR) were assessed every six months (M6-M24). Pegylated interferon alfa-2a (PEG-IFN) was offered to suboptimal responders. Results Sixty-one patients (median age: 45 years, 60.7% male, ACLD: 68.9%) receiving BLV for a median of 29.0 months were included. VR (M6: 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 through two years. Liver stiffness and systemic inflammation (i.e., CRP and PCT) decreased under BLV treatment (all p<0.01). Nineteen patients (31.1%) received add-on PEG-IFN 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 10 copies/mL and reductions in HBsAg levels by 0.08 (IQR 0.02-0.12) log 10 IU/L after 24 weeks of combined therapy (both p<0.01). Overall, 32.8% (20/61 patients) achieved HDV-RNA target not detected (TND). Ten (7 BLV mono, 3 BLV+PEG-IFN) stopped treatment after 23.0 (IQR 12.0-29.0) months. Seven patients maintained HDV-RNA TND through the last follow-up (median 36.0 months), whereas three patients relapsed but achieved TND again follo...