目的:Bulevirtide(BLV)是一流的进入抑制剂,也是欧洲唯一被批准用于慢性感染HDV患者的治疗方法。我们旨在研究BLV治疗在基线和治疗24或48周后获得的配对肝活检的疗效。
方法:我们对来自3项临床试验的126个配对肝活检进行了联合分析。在2期临床试验MYR202中,慢性丁型肝炎患者随机接受2毫克的24周BLV,5mg或10mg/天。MYR203(2期)和MYR301(3期)患者接受48周的2mg或10mg/天BLV治疗。富马酸替诺福韦酯单药治疗或延迟治疗作为比较。通过qPCR和免疫组织化学评估病毒学参数和感染相关的宿主基因。
结果:在第24周,中位肝内HDVRNA从基线下降为0.9Log10,2mg(n=7),1.1Log10与5mg(n=5)和1.4Log10与10mg(n=7)。在第48周,平均减少量为2.2Log10(2mg)(n=27)和2.7Log10(10mg)(n=37),而HDVRNA水平在比较臂中没有变化。值得注意的是,在所有BLV治疗组中,丁型肝炎抗原阳性肝细胞数量显著下降,同时炎性趋化因子和干扰素刺激基因的转录水平也随之下降.尽管HBsAg阳性肝细胞的丰度,辅助病毒HBV的复制和共价闭合环状DNA(cccDNA)水平较低,并且不受BLV治疗的影响。
结论:阻断病毒进入减少肝脏炎症的迹象,并促进肝脏内HDV感染的强烈减少,因此提示部分患者可通过长期治疗达到HDV治愈。
丁型肝炎病毒的慢性感染是最严重的病毒性肝炎,影响全世界约1200万人。进入抑制剂bulevirtide(BLV)是最近批准的唯一抗HDV药物,在临床试验和真实数据中已证明是有效和安全的。这里,我们调查了配对肝活检在基线和24或48周的治疗后,从三个临床试验,以了解药物对肝脏中的病毒和宿主参数的影响,病毒复制的位点。我们发现BLV治疗大大减少了HDV感染细胞的数量和肝脏炎症的迹象。该数据暗示阻断病毒进入改善肝脏炎症,并且延长治疗方案可能导致一些患者的HDV治愈。这一概念将为CHD患者的治疗策略和联合治疗的进一步发展提供信息。
OBJECTIVE: Bulevirtide (BLV) is a first-in-class entry inhibitor and the only approved treatment for patients chronically infected with
HDV in Europe. We aimed to investigate the efficacy of BLV treatment in paired liver biopsies obtained at baseline and after 24 or 48 weeks of treatment.
METHODS: We performed a combined analysis of 126 paired liver biopsies derived from three clinical trials. In the phase II clinical trial MYR202, patients with chronic hepatitis D were randomised to receive 24 weeks of BLV at 2 mg, 5 mg or 10 mg/day. Patients in MYR203 (phase II) and MYR301 (phase III) received 48 weeks of BLV at 2 mg or 10 mg/day. Tenofovir disoproxil fumarate monotherapy or delayed treatment served as comparators. Virological parameters and infection-related host genes were assessed by qPCR and immunohistochemistry.
RESULTS: At week 24, median intrahepatic
HDV RNA decline from baseline was 0.9Log10 with 2 mg (n = 7), 1.1Log10 with 5 mg (n = 5) and 1.4 Log10 with 10 mg (n = 7) of BLV. At week 48, median reductions were 2.2Log10 with 2 mg (n = 27) and 2.7Log10 with 10 mg (n = 37) of BLV, while
HDV RNA levels did not change in the comparator arms. Notably, a drastic decline in the number of hepatitis delta antigen-positive hepatocytes and a concomitant decrease in transcriptional levels of inflammatory chemokines and interferon-stimulated genes was determined in all BLV-treatment arms. Despite the abundance of HBsAg-positive hepatocytes, replication and covalently closed circular DNA levels of the helper virus HBV were low and remained unaffected by BLV treatment.
CONCLUSIONS: Blocking viral entry diminishes signs of liver inflammation and promotes a strong reduction of
HDV infection within the liver, thus suggesting that some patients may achieve HDV cure with long-term treatment.
UNASSIGNED: Chronic infection with
HDV causes the most severe form of viral hepatitis, affecting approximately 12 million people worldwide. The entry inhibitor bulevirtide (BLV) is the only recently approved anti-HDV drug, which has proven efficacious and safe in clinical trials and real-word data. Here, we investigated paired liver biopsies at baseline and after 24 or 48 weeks of treatment from three clinical trials to understand the effect of the drug on viral and host parameters in the liver, the site of viral replication. We found that BLV treatment strongly reduces the number of HDV-infected cells and signs of liver inflammation. This data implies that blocking viral entry ameliorates liver inflammation and that prolonged treatment regimens might lead to HDV cure in some patients. This concept will guide the further development of therapeutic strategies and combination treatments for patients with CHD.
BACKGROUND: NCT03546621, NCT02888106, NCT03852719.