Chronic hepatitis D—What is changing?
Corresponding Author
David Yardeni
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Correspondence
David Yardeni, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 4-5722, Bethesda, MD 20892, USA.
Email: [email protected]
Christopher Koh, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD 20892, USA.
Email: [email protected]
Search for more papers by this authorTheo Heller
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorCorresponding Author
Christopher Koh
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Correspondence
David Yardeni, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 4-5722, Bethesda, MD 20892, USA.
Email: [email protected]
Christopher Koh, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD 20892, USA.
Email: [email protected]
Search for more papers by this authorCorresponding Author
David Yardeni
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Correspondence
David Yardeni, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 4-5722, Bethesda, MD 20892, USA.
Email: [email protected]
Christopher Koh, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD 20892, USA.
Email: [email protected]
Search for more papers by this authorTheo Heller
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorCorresponding Author
Christopher Koh
Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Correspondence
David Yardeni, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 4-5722, Bethesda, MD 20892, USA.
Email: [email protected]
Christopher Koh, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD 20892, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Hepatitis D virus (HDV) infection is a chronic viral disease of the liver that is still largely considered to be incurable due to lack of effective treatment options. Without treatment, the risk for the development of advanced liver disease, cirrhosis and hepatocellular carcinoma is significantly high. Currently, new therapeutic options are emerging out of ongoing phase 3 clinical trials, promising a new hope of cure for this devastating liver infection. Recently, bulevirtide, a first in its class HDV entry inhibitor, has received conditional authorization of use from the European Medicines Agency (EMA) and was also submitted for approval in the United States. Other novel therapeutic options in clincal trials include interferon lambda, the prenylation inhibitor lonafarnib and nucleic acidic polymers (NAPs). This review describes all recent advances and ongoing changes to the field of HDV therpaeutics.
CONFLICT OF INTEREST
The authors declare they have no competing interests.
Open Research
DATA AVAILABILITY STATEMENT
The authors confirm that the data supporting the findings of this study are available within the article or its supplementary materials.
REFERENCES
- 1Caviglia GP, Rizzetto M. Treatment of hepatitis D: an unmet medical need. Clin Microbiol Infect. 2020; 26: 824-827.
- 2Noureddin M, Gish R. Hepatitis delta: epidemiology, diagnosis and management 36 years after discovery. Curr Gastroenterol Rep. 2014; 16: 365.
- 3Rizzetto M. The adventure of delta. Liver Int. 2016; 36(Suppl 1): 135-140.
- 4Rizzetto M, Canese MG, Aricò S, et al. Immunofluorescence detection of new antigen-antibody system (delta/anti-delta) associated to hepatitis B virus in liver and in serum of HBsAg carriers. Gut. 1977; 18: 997-1003.
- 5Rizzetto M, Hoyer B, Canese MG, Shih JW, Purcell RH, Gerin JL. delta agent: association of delta antigen with hepatitis B surface antigen and RNA in serum of delta-infected chimpanzees. Proc Natl Acad Sci USA. 1980; 77: 6124-6128.
- 6Wang KS, Choo QL, Weiner AJ, et al. Structure, sequence and expression of the hepatitis delta (delta) viral genome. Nature. 1986; 323: 508-514.
- 7Romeo R, Del Ninno E, Rumi M, et al. A 28-year study of the course of hepatitis delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology. 2009; 136: 1629-1638.
- 8Chang MS, Nguyen MH. Epidemiology of hepatitis B and the role of vaccination. Best Pract Res Clin Gastroenterol. 2017; 31: 239-247.
- 9Rizzetto M, Hepatitis D. Virus: introduction and epidemiology. Cold Spring Harb Perspect Med. 2015; 5: a021576.
- 10Safaie P, Razeghi S, Rouster SD, Privitera I, Sherman KE. Hepatitis D diagnostics: utilization and testing in the United States. Virus Res. 2018; 250: 114-117.
- 11Gish R, Jacobson I, Lim J, et al. Prevalence and characteristics of hepatitis delta in the United States: an analysis of all-payer claims database. Hepatology. 2021; 74: 1-156.
- 12Osiowy C, Swidinsky K, Haylock-Jacobs S, et al. Molecular and clinical epidemiology of hepatitis D virus infection in Canada. Hepatology. 2021; 74: 1-156.
- 13Braga WS, Castilho Mda C, Borges FG, et al. Hepatitis D virus infection in the Western Brazilian amazon - far from a vanishing disease. Rev Soc Bras Med Trop. 2012; 45: 691-695.
- 14Makuwa M, Mintsa-Ndong A, Souquière S, Nkoghé D, Leroy EM, Kazanji M. Prevalence and molecular diversity of hepatitis B virus and hepatitis delta virus in urban and rural populations in northern Gabon in central Africa. J Clin Microbiol. 2009; 47: 2265-2268.
- 15Tsatsralt-Od B, Takahashi M, Endo K, et al. Infection with hepatitis A, B, C, and delta viruses among patients with acute hepatitis in Mongolia. J Med Virol. 2006; 78: 542-550.
- 16Rizzetto M, Ciancio A. Epidemiology of hepatitis D. Semin Liver Dis. 2012; 32: 211-219.
- 17Palom A, Riveiro Barciela M, Barreira-Diaz A, et al. Low adherence to guidelines recommendation for testing hepatitis D in HBsAg positive patients leads to a high rate of undiagnosis. Hepatology. 2021; 74: 1-156.
- 18Gish RG, Yi DH, Kane S, et al. Coinfection with hepatitis B and D: epidemiology, prevalence and disease in patients in Northern California. J Gastroenterol Hepatol. 2013; 28: 1521-1525.
- 19Le Gal F, Brichler S, Sahli R, Chevret S, Gordien E. First international external quality assessment for hepatitis delta virus RNA quantification in plasma. Hepatology. 2016; 64: 1483-1494.
- 20Flores R, Ruiz-Ruiz S, Serra P. Viroids and hepatitis delta virus. Semin Liver Dis. 2012; 32: 201-210.
- 21Weiner AJ, Choo QL, Wang KS, et al. A single antigenomic open reading frame of the hepatitis delta virus encodes the epitope(s) of both hepatitis delta antigen polypeptides p24 delta and p27 delta. J Virol. 1988; 62: 594-599.
- 22Sharmeen L, Kuo MY, Dinter-Gottlieb G, Taylor J. Antigenomic RNA of human hepatitis delta virus can undergo self-cleavage. J Virol. 1988; 62: 2674-2679.
- 23Sheu GT. Initiation of hepatitis delta virus (HDV) replication: HDV RNA encoding the large delta antigen cannot replicate. J Gen Virol. 2002; 83: 2507-2513.
- 24Hwang SB, Lai MM. Isoprenylation mediates direct protein-protein interactions between hepatitis large delta antigen and hepatitis B virus surface antigen. J Virol. 1993; 67: 7659-7662.
- 25Glenn JS, Watson JA, Havel CM, White JM. Identification of a prenylation site in delta virus large antigen. Science. 1992; 256: 1331-1333.
- 26Ryu WS, Netter HJ, Bayer M, Taylor J. Ribonucleoprotein complexes of hepatitis delta virus. J Virol. 1993; 67: 3281-3287.
- 27Sureau C. The role of the HBV envelope proteins in the HDV replication cycle. Curr Top Microbiol Immunol. 2006; 307: 113-131.
- 28Yan H, Zhong G, Xu G, et al. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus. Elife. 2012; 1:e00049.
- 29Persing DH, Varmus HE, Ganem D. The preS1 protein of hepatitis B virus is acylated at its amino terminus with myristic acid. J Virol. 1987; 61: 1672-1677.
- 30Alves C, Freitas N, Cunha C. Characterization of the nuclear localization signal of the hepatitis delta virus antigen. Virology. 2008; 370: 12-21.
- 31Dény P. Hepatitis delta virus genetic variability: from genotypes I, II, III to eight major clades? Curr Top Microbiol Immunol. 2006; 307: 151-171.
- 32Le Gal F, Brichler S, Drugan T, et al. Genetic diversity and worldwide distribution of the deltavirus genus: a study of 2,152 clinical strains. Hepatology. 2017; 66: 1826-1841.
- 33Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018; 67: 1560-1599.
- 34Hepatitis C. Guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clin Infect Dis. 2018; 67: 1477-1492.
- 35Garripoli A, Di Marco V, Cozzolongo R, et al. Ribavirin treatment for chronic hepatitis D: a pilot study. Liver. 1994; 14: 154-157.
- 36Yurdaydin C, Bozkaya H, Gürel S, et al. Famciclovir treatment of chronic delta hepatitis. J Hepatol. 2002; 37: 266-271.
- 37Niro GA, Ciancio A, Tillman HL, et al. Lamivudine therapy in chronic delta hepatitis: a multicentre randomized-controlled pilot study. Aliment Pharmacol Ther. 2005; 22: 227-232.
- 38Farci P, Mandas A, Coiana A, et al. Treatment of chronic hepatitis D with interferon alfa-2a. N Engl J Med. 1994; 330: 88-94.
- 39 EASL. Clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017; 2017(67): 370-398.
- 40Farci P, Roskams T, Chessa L, et al. Long-term benefit of interferon alpha therapy of chronic hepatitis D: regression of advanced hepatic fibrosis. Gastroenterology. 2004; 126: 1740-1749.
- 41Castelnau C, Le Gal F, Ripault MP, et al. Efficacy of peginterferon alpha-2b in chronic hepatitis delta: relevance of quantitative RT-PCR for follow-up. Hepatology. 2006; 44: 728-735.
- 42Wedemeyer H, Yurdaydìn C, Dalekos GN, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med. 2011; 364: 322-331.
- 43Heidrich B, Yurdaydın C, Kabaçam G, et al. Late HDV RNA relapse after peginterferon alpha-based therapy of chronic hepatitis delta. Hepatology. 2014; 60: 87-97.
- 44Keskin O, Wedemeyer H, Tüzün A, et al. Association between level of hepatitis D virus RNA at week 24 of pegylated interferon therapy and outcome. Clin Gastroenterol Hepatol. 2015; 13: 2342-2349.e1-2.
- 45Wedemeyer H, Yurdaydin C, Hardtke S, et al. Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): a randomised, placebo controlled, phase 2 trial. Lancet Infect Dis. 2019; 19: 275-286.
- 46Heller T, Rotman Y, Koh C, et al. Long-term therapy of chronic delta hepatitis with peginterferon alfa. Aliment Pharmacol Ther. 2014; 40: 93-104.
- 47Hercun J, Kim GE, Da BL, et al. Durable virological response and functional cure of chronic hepatitis D after long-term peginterferon therapy. Aliment Pharmacol Ther. 2021; 54: 176-182.
- 48Konerman MA, Lok AS. Interferon treatment for hepatitis B. Clin Liver Dis. 2016; 20: 645-665.
- 49 Hepcludex, product information. European Medicines Agency. https://www.ema.europa.eu/en/medicines/human/EPAR/hepcludex. Accessed January 30, 2022.
- 50 Gilead. Gilead submits biologics license application to U.S. food and drug administration for bulevirtide, an investigational treatment for people living with chronic hepatitis delta. Gilead.com: Gilead; 2021.
- 51Blank A, Markert C, Hohmann N, et al. First-in-human application of the novel hepatitis B and hepatitis D virus entry inhibitor myrcludex B. J Hepatol. 2016; 65: 483-489.
- 52Bogomolov P, Alexandrov A, Voronkova N, et al. Treatment of chronic hepatitis D with the entry inhibitor myrcludex B: first results of a phase Ib/IIa study. J Hepatol. 2016; 65: 490-498.
- 53Wedemever H, Alexandrov A, Bogomolov P, et al. Interim results of a multicenter, open-label phase 2b clinical trial to assess safety and efficacy of myrcludex B in combination with tenofovir in patients with chronic HBV/HDV co-infection. Oral Abstracts (Abstracts 1–263). Hepatology. 2017; 66: 1–148.
- 54Wedemeyer H, Bogomolov P, Blank A, et al. Final results of a multicenter, open-label phase 2b clinical trial toassess safety and efficacy of myrcludex B in combination with tenofovir in patients with chronic HBV/HDV co-infection. J Hepatol. 2018; 68(1):S32018.
- 55Wedemeyer H, Schönweis K, Bogomolov P, et al. Final results of a multicenter, open-label phase 2 clinical trial (MYR203) to assess safety and efficacy of myrcludex B in combination with peg-interferon alpha 2a in patients with chronic HBV/HDV co-infection. J Hepatol. 2019; 70:S3.
- 56Wedemeyer H, Schöneweis K, Bogomolov P, et al. 48 weeks of high dose (10mg) bulevirtide as monotherapy or with peginterferon alfa-2a in patients with chronic HBV/HDV co-infection. J Hepatol. 2020; 73: S52-S53.
- 57Asselah TAS, Bogomolov P, Bourliere M, Fontaine H, Gherlan GS. Safety and efficacy of bulevirtide monotherapy and in combination with peginterferon alfa-2a in patients with chronic hepatitis delta: 24 weeks interim data of MYR204 Phase 2b study. J Hepatol. 2021; 75:S291.
- 58Wedemever H, Aleman S, Andreone P, et al. Bulevirtide monotherapy at low and high dose in patients with chronic hepatitis delta: 24 weeks interim data of the phase 3 MYR301 study. J Hepatol. 2021; 75: S294-S295.
- 59Lasfar A, Zloza A, Cohen-Solal KA. IFN-lambda therapy: current status and future perspectives. Drug Discov Today. 2016; 21: 167-171.
- 60Chan HLY, Ahn SH, Chang TT, et al. Peginterferon lambda for the treatment of HBeAg-positive chronic hepatitis B: a randomized phase 2b study (LIRA-B). J Hepatol. 2016; 64: 1011-1019.
- 61Foster GR, Chayama K, Chuang WL, et al. A randomized, controlled study of peginterferon lambda-1a/ribavirin ± daclatasvir for hepatitis C virus genotype 2 or 3. Springerplus. 2016; 5: 1365.
- 62Etzion O, Duehren S & Hamid SS et al. Characterization of HDV, HBsAg and ALT kinetics under peginterferon-lambda monotherapy: the phase 2 LIMT study. Hepatology 2019;70,1477A-1501A
- 63 Eiger Biopharmaceutricals Phase 3 LIMIT-2 study.https://www.eigerbio.com/lambda-hdv-infection, accessed on January 30 2022
- 64Glenn JS, Marsters JC Jr, Greenberg HB. Use of a prenylation inhibitor as a novel antiviral agent. J Virol. 1998; 72: 9303-9306.
- 65Bordier BB, Ohkanda J, Liu P, et al. In vivo antiviral efficacy of prenylation inhibitors against hepatitis delta virus. J Clin Invest. 2003; 112: 407-414.
- 66Koh C, Canini L, Dahari H, et al. Oral prenylation inhibition with lonafarnib in chronic hepatitis D infection: a proof-of-concept randomised, double-blind, placebo-controlled phase 2A trial. Lancet Infect Dis. 2015; 15: 1167-1174.
- 67Yurdaydin C, Keskin O, Kalkan Ç, et al. Optimizing lonafarnib treatment for the management of chronic delta hepatitis: the LOWR HDV-1 study. Hepatology. 2018; 67: 1224-1236.
- 68Yurdaydin CIR, Keskin O, et al. A phase 2 dose-optimization study of lonafarnib with ritonavir for the treatment of chronic delta hepatitis-end of treatment results from the LOWR HDV-2 study. J Hepatol. 2017; 66(1): S33-S34.
- 69Koh CSP, Han T, et al. A phase 2 study exploring once daily dosing of ritonavir boosted lonafarnib for the treatment of chronic delta hepatitis – end of study results results from from the LOWR HDV-3 study. J Hepatol. 2017; 66: S101-S102.
- 70Wedemeyer HPK, Deterding K, et al. A phase 2 dose-escalation study of lonafarnib plus ritonavir in patients with chronic hepatitis D: final results from the lonafarnib with ritonavir in HDV-4 (LOWR HDV-4) study. J Hepatol. 2017; 66(1):S24.
- 71Koh C, Hercun J, Rahman F, et al. A phase 2 study of peginterferon lambda, lonafarnib and ritonavir for 24 weeks: end-of- study results from the LIFT HDV study. Presented at The Liver Meeting. 2020. https://www.eigerbio.com/lambda-hdv-infection. Accessed January 30, 2022.
- 72Vaillant A. Nucleic acid polymers: broad spectrum antiviral activity, antiviral mechanisms and optimization for the treatment of hepatitis B and hepatitis D infection. Antiviral Res. 2016; 133: 32-40.
- 73Noordeen F, Vaillant A, Jilbert AR. Nucleic acid polymers inhibit duck hepatitis B virus infection in vitro. Antimicrob Agents Chemother. 2013; 57: 5291-5298.
- 74Noordeen F, Scougall CA, Grosse A, et al. Therapeutic antiviral effect of the nucleic acid polymer REP 2055 against persistent duck hepatitis B virus infection. PLoS One. 2015; 10:e0140909.
- 75Al-Mahtab M, Bazinet M, Vaillant A. Safety and efficacy of nucleic acid polymers in monotherapy and combined with immunotherapy in treatment-naive bangladeshi patients with HBeAg+ chronic hepatitis B infection. PLoS One. 2016; 11:e0156667.
- 76Bazinet M, Pântea V, Cebotarescu V, et al. Safety and efficacy of REP 2139 and pegylated interferon alfa-2a for treatment-naive patients with chronic hepatitis B virus and hepatitis D virus co-infection (REP 301 and REP 301-LTF): a non-randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol. 2017; 2: 877-889.
- 77Bazinet M, Pântea V, Cebotarescu V, et al. Persistent control of hepatitis B virus and hepatitis delta virus infection following REP 2139-Ca and pegylated interferon therapy in chronic hepatitis B virus/hepatitis delta virus coinfection. Hepatol Commun. 2021; 5: 189-202.