Correlation of Bile Acid Dynamics to Bulevirtide Response and Disease Severity in Patients With Hepatitis D

作者：Marlene Hintersteininger, Michael Schwarz, Philipp Schwabl, Lukas Hartl, Lorenz Balcar, Benedikt Hofer, Georg Kramer, Christian Sebesta, Paul Thöne, Patrik Attalla, Michael Gschwantler, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, Mathias Jachs · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2026 · DOI：10.1111/apt.70675 · 被引用次数：2 · 研究领域：Liver Diseases and Immunity、Hepatitis B Virus Studies、Hepatitis C virus research

BACKGROUND: Bulevirtide (BLV) blocks hepatitis D virus (HDV) entry by targeting the sodium taurocholate co-transporting polypeptide (NTCP). This study assessed the relationship between bile acid (BA) levels and antiviral response to BLV. METHODS: decline in HDV-RNA and discriminated versus virologic non-response (VNR). Delta BA levels (ΔBA) were calculated and analysed in relation to HDV-RNA dynamics. Finally, the effect of BLV treatment cessation on BA was investigated. RESULTS: Twenty five patients (48% male; advanced chronic liver disease [ACLD]: 92.0%, 17 patients with VR at W48) were included. Median baseline BA levels were significantly higher in patients with ACLD and portal hypertension (n = 10; 19.2 vs. 5.1 μmol/L; p = 0.015). No difference in median on-treatment BA levels was detected between patients achieving VR or VNR at W24 (VR: 25.4 vs. VNR: 22.7 μmol/L; p = 1.000) and W48 (VR: 25.4 vs. VNR: 20.8 μmol/L; p = 1.000). Additionally, ΔBA from baseline to W48 did not differ between VR and VNR (p = 0.534). No significant association between ΔBA and HDV-RNA dynamics at W48 was detected. After BLV discontinuation, median BA levels significantly dropped to normal ranges (18.9 μmol/L at last on-BLV assessment to 7.6 μmol/L after discontinuation; p = 0.028). On-treatment BA levels did neither associate with self-reported compliance nor with treatment-related adverse events. CONCLUSION: Bulevirtide increases bile acid levels in most patients, but ΔBA does not predict virol...