Therapy goals
- Reduction of HDV RNA levels and eventual signs of liver inflammation in treated patients.
- An important foundation of hepatitis D therapy is optimal therapy for hepatitis B.
- In chronic hepatitis B, therapy should be directed toward normalization of transaminases and the lowest possible viral load (< 300 copies of HBV DNA/ml).
Therapy recommendations
- Bulevirtide (Hepcludex): first drug approved against hepatitis D in the EU for the treatment of chronic hepatitis delta virus (HDV) infection in adult patients with compensated liver disease.Bulevirtide (Hepcludex).
- Another therapeutic option has been treatment with interferon α or PEG-interferon interferon α (PEG-IFN); duration of therapy: > 48 weeks; in patients with significant HBsAg decline in the first 48 weeks, a longer duration of therapy should be considered if well tolerated (see “Further guidance” below).
Further notes
- A 48-week course of therapy with PEG-IFN in therapy-naive patients showed that the efficacy of PEG-IFN in hepatitis D is limited.
- HIDIT-II study: prolongation of therapy in hepatitis D can inhibit disease progression, but it does not result in significantly higher cure rates.
