Managing Chronic Hepatitis D Infection with Tobevibart & Elebsiran
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on March 4th, 2026
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While not as frequently discussed, Hepatitis D viral infection is a severe chronic condition that can significantly increase the risk of cirrhosis and eventual hepatocellular carcinoma. The infection can be managed with bulevirtide. However, bulevirtide usage is troublesome due to the need of daily subcutaneous injections. Plus, patients have a high risk of relapse of treatment stop. Due to a need for a new therapy, a study was performed to explore the usage of tobevibart plus elebsiran to manage hepatitis D infection.
Funding Source(s): Vir Biotechnology
The phase 2 clinical study included 65 participants who had been diagnosed with chronic hepatitis D infection with an average serum HDV RNA level of approximately 5.6 log IU per mL, with 97% of the infection caused by HDV genotype 1. Around 50% of the patients were previously diagnosed with cirrhosis, and their liver stiffness was measured by FibroScan to be 13.5 kPa, on average. Baseline biochemical analysis found the cohort has a mean ALT level of 80 U/Liter.
The patients were randomly assigned to be treated subcutaneously with either 300 mg of tobevibart every 2 weeks or a combination of tobevibart (300 mg) plus elebsiran (200 mg) every 4 weeks. After 48 weeks of treatment, the researchers found that both the tobevibart monotherapy and the tobevibart plus elebsiran combination were effective at reducing the hepatitis D virus & ALT level. Despite this beneficial clinical outcome, additional studies are needed to compare these experimental antivirals to proven agents such as bulevirtide. Future studies should also consider increasing the number of participants, and enroll patients infected with other HDV genotypes.
Funding Source(s): Vir Biotechnology
The phase 2 clinical study included 65 participants who had been diagnosed with chronic hepatitis D infection with an average serum HDV RNA level of approximately 5.6 log IU per mL, with 97% of the infection caused by HDV genotype 1. Around 50% of the patients were previously diagnosed with cirrhosis, and their liver stiffness was measured by FibroScan to be 13.5 kPa, on average. Baseline biochemical analysis found the cohort has a mean ALT level of 80 U/Liter.
The patients were randomly assigned to be treated subcutaneously with either 300 mg of tobevibart every 2 weeks or a combination of tobevibart (300 mg) plus elebsiran (200 mg) every 4 weeks. After 48 weeks of treatment, the researchers found that both the tobevibart monotherapy and the tobevibart plus elebsiran combination were effective at reducing the hepatitis D virus & ALT level. Despite this beneficial clinical outcome, additional studies are needed to compare these experimental antivirals to proven agents such as bulevirtide. Future studies should also consider increasing the number of participants, and enroll patients infected with other HDV genotypes.