MILAN (ITALPRESS) – After decades characterized by very limited therapeutic possibilities, for the Hepatite Cronica Delta opens a new phase. It has emerged in the fifth edition of the International Delta Cure Meeting in Milan, chaired by Pietro Lampertico, Professor of Gastroenterology at the University of Milan and Director of Gastroenterology and Epathology of the IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, and Heiner Wedemeyer, Director of the Department of Gastroenterology, Epathology, Infectious Diseases and Endocrinology of the School of Medicine of Hanover. In Italy as in the rest of the world, HDV is interested in numbers that are contained in other hepatitis: in Italy, estimates indicate patients with active infection in the order of a few thousand. Rarity, however, does not reduce its clinical relevance, precisely because of the rapidity with which the disease can evolve and for the relatively young age of many patients and the absence of specific therapies for many years. “The hepatitis Delta is a rare disease, but it is the most aggressive form of chronic viral hepatitis: it can affect young people and quickly progress towards cirrhosis, discompensation, hepatocarcinoma and transplant – says Professor Pietro Lampertico. From the discovery by Professor Mario Rizzetto in 1977 to 2023 this disease has remained without approved therapies; today, instead, we have a first drug available in clinical practice and, above all, numerous new therapeutic strategies in advanced development. In recent years the HDV landscape has had an extraordinary acceleration.” The first paradigm shift has arrived with bulevirtide, today the only specific treatment available in clinical practice for chronic hepatitis Delta. The experience accumulated in recent years has shown virological and biochemical responses that tend to consolidate over time and an excellent safety profile even in patients with advanced liver disease. A recent European multicentric study coordinated by the Milanese centre also showed, in treated cirrhotic patients, a reduction of about 80% of the risk of uncompensation after 3 years of therapy. The surveillance for hepatocarcinoma remains central, the risk of which is not cancelled by treatment. The second major novelty concerns what might come in the coming years. The congress will present new data on three strategies already in phase 3, between monoclonal antibodies in monotherapy or in combination with direct molecules against HBV RNA (siRNA). In addition to these, there are other approaches in development and, looking at 2027, the results of numerous studies are expected. The passage is substantial: from one therapeutic option to a potentially wider panorama, in which it will be possible to differentiate the treatments according to the characteristics of the patient and the disease. In addition to long-term suppressive therapies, definite life strategies are also being studied. Some programs provide treatments of about 48 weeks, with the aim of obtaining in selected subgroups a sustained response even after suspension. “ Today bulevirtide is the only drug available in clinical practice, but it requires prolonged administration – explains Lampertico Professor – Parallelly they are advancing new strategies: some are long-term suppressive treatments, others instead aim to obtain, in selected patients, a sustained response after a definite duration therapy cycle. It is also an important change in quality of life and long-term management of the disease.” Evolution also concerns diagnosis. Recommendations provide that each positive HBsAg person is tested at least once for antibodies HDV; however, this step is not systematically performed in all patients. Some centers have therefore introduced reflex testing programs, in which the testantiHDV is automatically performed in HBsAg subjects positive. A recent novelty also comes from the update of the Essential Support Levels (LEA): among the performance of the outpatient specialist the quantitative HDV-RNA test was also included, used to document the active infection and follow its course. A further research front concerns the new drugs developed against hepatitis B. As Delta virus depends on HBV to complete its life cycle, strategies capable of obtaining the so-called “functional care” of hepatitis B, i.e. obtaining negativity for HBsAg, could in the future have an impact on HDV, opening up to the possibility of combining direct therapies against Delta with treatments capable of eliminating the support provided by HBV. The 5th International Delta Cure Meeting was held at the Fondazione Cariplo Conference Center in Milan. The program included epidemiology, virology, immunology, diagnostics, natural history, treatments available, developing drugs and unmet needs. For the first time, the accepted abstracts were published in a dedicated BMJ Open Gastroenterology supplement.
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