Response-guided bulevirtide ± pegylated interferon alfa-2a: Long-term outcomes observed in the nationwide Austrian hepatitis D cohort study

Background & Aims Chronic hepatitis D (CHD) often progresses to advanced chronic liver disease (ACLD). Bulevirtide (BLV) is approved for CHD, yet treatment duration, management of suboptimal response, and the potential for finite treatment remain unclear. Methods Patients receiving BLV at ten Austrian centers were included. Virological, biochemical, and combined response (VR/BR/CR) were assessed every six months (M6-M24). Pegylated interferon alfa-2a (PEG-IFN) was offered to suboptimal responders. Results Sixty-one patients (median age: 45 years, 60.7% male, ACLD: 68.9%) receiving BLV for a median of 29.0 months were included. VR (M6: 36.4%, M12: 64.2%, M24: 61.9%), BR (M6: 56.4%, M12: 69.8%, M24: 66.7%), and CR (M6: 25.5%, M12: 47.2%, M24: 42.9%) were maintained through two years. Liver stiffness and systemic inflammation (i.e., CRP and PCT) decreased under BLV treatment (all p