Bulevirtide for Hepatitis D

Recruiting at 6 trial locations

Overseen By Gilead Clinical Study Information Center

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: Gilead Sciences

Must not be taking: Steroids, Immunosuppressants, Chemotherapy, others

Disqualifiers: HIV, Hepatitis B, Hepatitis C, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

74 Participants Needed

Trial Summary

What is the purpose of this trial?

The goals of this study are to measure the amount of bulevirtide (BLV) that gets into the blood stream and how long it takes to get rid of it, measure the effect of BLV on bile acids, and evaluate the safety and tolerability of multiple doses of BLV in participants with normal and impaired hepatic (liver) function.

Do I need to stop taking my current medications for this trial?

The protocol does not specify if you must stop taking your current medications. However, individuals with hepatic impairment should have been on a stable dose of their medications for at least 4 weeks prior to screening, and any changes in medication should be reviewed and approved by the sponsor. Matched control individuals with normal hepatic function should not have taken any prescription or over-the-counter medications, except for certain exceptions, within 28 days prior to the study.

What data supports the idea that Bulevirtide for Hepatitis D is an effective drug?

The available research shows that Bulevirtide, also known as Hepcludex, is effective in treating Hepatitis D. In a study, patients treated with Bulevirtide, either alone or in combination with another drug called pegylated interferon, showed a significant decrease in the virus levels in their blood. For example, in a real-life study, four patients who received the combination treatment had a noticeable drop in virus levels after 12 and 24 weeks. Additionally, some patients achieved normal liver enzyme levels, indicating improved liver function. These results suggest that Bulevirtide is a promising option for treating Hepatitis D. ^{1 2 3 4 5}

What safety data is available for Bulevirtide treatment?

Bulevirtide, also known as Hepcludex, MyrB, Myrcludex-B, and 915207G, has been evaluated for safety in several studies. It was approved in the EU for chronic HDV infection, indicating a favorable safety profile. In a case report of three patients with HDV-related compensated cirrhosis treated with MyrB 10 mg/day for 48 weeks, the treatment was well tolerated, and patients remained asymptomatic despite increased bile acids. Another study with Bulevirtide (2 mg/day) plus tenofovir disoproxil fumarate showed no recorded adverse effects after 24 weeks, confirming safety and tolerability. Additionally, a large real-world cohort study of 114 patients treated with Bulevirtide at 2 mg/day reported safety data, supporting its use in clinical settings. ^{1 3 6 7 8}

Is the drug Bulevirtide a promising treatment for Hepatitis D?

Yes, Bulevirtide is a promising drug for treating Hepatitis D. It has been approved in the European Union and has shown positive results in reducing the virus in patients. It works by blocking the virus from entering liver cells, which helps control the infection. ^{1 2 3 5 8}

Research Team

Gilead Study Director

Principal Investigator

Gilead Sciences

Eligibility Criteria

This trial is for individuals with chronic Hepatitis D, who are healthy enough as per medical evaluation, have a BMI between 19-40 kg/m^2, and kidney function above a certain level. They must agree to use contraception if applicable and not donate blood during the study. People with recent drug treatments or substance abuse issues, significant allergies or serious health conditions cannot participate.

Inclusion Criteria

I have liver issues but meet specific health criteria and have been on stable medication for 4 weeks.

All individuals must have a body mass index (BMI) of at least 19 and no greater than 40 kg/m^2 at screening.

All individuals must have 12-lead electrocardiogram (ECG) evaluations at screening without clinically significant abnormalities.

Exclusion Criteria

All individuals must not have current alcohol or substance abuse that could interfere with individual compliance or safety.

I do not have issues with blood draws due to poor vein access.

All individuals must not have received any study drug within 30 days prior to study dosing.

Treatment Details

Interventions

• Bulevirtide

Trial Overview The study tests Bulevirtide in people with varying liver functions. It measures how much of the drug enters the bloodstream, its elimination rate, impact on bile acids, and assesses safety over multiple doses.

Participant Groups

Group I: Group D: BLV, Severe Hepatic Impairment Experimental Treatment 1 Intervention

Participants from Group B, whose safety and PK data had been reviewed and their matched control group participants with normal hepatic function, will receive BLV 10 mg injection once daily for 6 days.

Group II: Group C: Bulevirtide (BLV), Moderate Hepatic Impairment Experimental Treatment 1 Intervention

Participants from Group A, whose safety and phamacokinetic (PK) data had been reviewed and their matched control group participants with normal hepatic function, will receive BLV 10 mg injection once daily for 6 days.

Group III: Group B: BLV, Severe Hepatic Impairment Experimental Treatment 1 Intervention

Participants with severe hepatic impairment and their matched control group participants with normal hepatic function will receive BLV 2 mg injection once daily for 6 days starting on Day 1.

Group IV: Group A: Bulevirtide (BLV), Moderate Hepatic Impairment Experimental Treatment 1 Intervention

Participants with moderate hepatic impairment and their matched control group participants with normal hepatic function will receive BLV 2 mg injection once daily for 6 days starting on Day 1.

Bulevirtide is already approved in European Union for the following indications:

Approved in European Union as Hepcludex for:

• Chronic hepatitis delta virus (HDV) infection in plasma (or serum) HDV-RNA positive adult patients with compensated liver disease

Who Is Running the Clinical Trial?

Gilead Sciences

Lead Sponsor

Trials

1,150

Recruited

878,000+

Daniel O'Day

Gilead Sciences

Chief Executive Officer since 2019

MBA from Columbia University

Dietmar Berger

Gilead Sciences

Chief Medical Officer

MD and PhD from Albert-Ludwigs University School of Medicine

Findings from Research

Bulevirtide (Hepcludex®) is the first entry inhibitor approved in the European Union for treating chronic hepatitis delta virus (HDV) infections in adults with compensated liver disease.

The approval of bulevirtide marks a significant milestone in the treatment of chronic HDV and chronic hepatitis B virus (HBV) infections, highlighting its potential as a new therapeutic option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bulevirtide: First Approval. Kang, C., Syed, YY.[2021]

Myrcludex B, a new entry inhibitor for hepatitis B and D, was well tolerated in a pilot trial with 24 patients, showing no serious adverse events and significant reductions in HDV RNA levels after 24 weeks of treatment.

The combination of Myrcludex B with pegylated interferon alpha (PegIFNα-2a) demonstrated a strong synergistic effect, leading to negative HDV RNA results in five out of seven patients, indicating enhanced efficacy in treating chronic hepatitis delta virus infection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of chronic hepatitis D with the entry inhibitor myrcludex B: First results of a phase Ib/IIa study. Bogomolov, P., Alexandrov, A., Voronkova, N., et al.[2018]

Myrcludex B, a new treatment for hepatitis B and D, was well tolerated in a phase I clinical trial involving 36 healthy volunteers, with no serious adverse effects observed even at the highest dose of 20mg.

The pharmacokinetics of Myrcludex B followed a 2-compartment model, showing that subcutaneous doses of 10mg and above can achieve over 80% target saturation for at least 15 hours, which is important for planning future efficacy trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

First-in-human application of the novel hepatitis B and hepatitis D virus entry inhibitor myrcludex B. Blank, A., Markert, C., Hohmann, N., et al.[2018]

Myrcludex B is a novel entry inhibitor that effectively blocks HBV and HDV from entering liver cells by targeting the sodium-taurocholate co-transporting polypeptide, which is the main receptor for these viruses.

This drug not only inhibits HBV replication but also shows potential for further development, as it is being considered for phase III clinical trials, addressing the urgent need for new antiviral treatments for chronic hepatitis B and D infections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical effects of NTCP-inhibitor myrcludex B. Cheng, D., Han, B., Zhang, W., et al.[2021]

Bulevirtide (BLV) shows promising early virological efficacy in treating chronic hepatitis delta (CHD), with four out of six patients experiencing significant declines in HDV viral load after 12 and 24 weeks of treatment, especially those receiving combination therapy with pegylated interferon.

The treatment was generally well-tolerated, although one patient experienced thrombocytopenia leading to treatment cessation, highlighting the need for monitoring side effects. Overall, these preliminary results support the potential of BLV as a new therapeutic option for CHD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early virological response in six patients with hepatitis D virus infection and compensated cirrhosis treated with Bulevirtide in real-life. Asselah, T., Loureiro, D., Le Gal, F., et al.[2022]

In a compassionate use study of 3 European patients with HDV-related compensated cirrhosis, long-term treatment with Myrcludex-B (MyrB) at 10 mg/day for 48 weeks was found to be safe and effective, leading to undetectable HDV RNA levels in two patients and significant improvements in liver function tests.

MyrB treatment resulted in normalization of alanine aminotransferase levels and improvements in portal hypertension features, demonstrating its potential as a viable therapy for patients with advanced liver disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Excellent safety and effectiveness of high-dose myrcludex-B monotherapy administered for 48 weeks in HDV-related compensated cirrhosis: A case report of 3 patients. Loglio, A., Ferenci, P., Uceda Renteria, SC., et al.[2020]

In a real-life study involving seven patients with chronic hepatitis delta, the combination of bulevirtide (BLV) and tenofovir disoproxil fumarate (TDF) showed promising efficacy, with five out of seven patients achieving a significant reduction in HDV RNA after 24 weeks.

The treatment was well-tolerated with no reported adverse effects, confirming the safety and efficacy of BLV as seen in the earlier MYR202 trial, even with extended treatment in some cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Bulevirtide plus Tenofovir Disoproxil Fumarate in Real-World Patients with Chronic Hepatitis B and D Co-Infection. Herta, T., Hahn, M., Maier, M., et al.[2023]

In a study involving 114 patients with chronic hepatitis D, bulevirtide treatment resulted in a significant virologic response in 76% of cases, with a mean time to response of 23 weeks, demonstrating its efficacy as a monotherapy.

The treatment was well tolerated with no serious drug-related adverse events reported, and improvements in liver inflammation were noted even in patients who did not achieve a virologic response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treating hepatitis D with bulevirtide - Real-world experience from 114 patients. Dietz-Fricke, C., Tacke, F., Zöllner, C., et al.[2023]

References

1. New Zealand pubmed.ncbi.nlm.nih.gov

Bulevirtide: First Approval. [2021]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Treatment of chronic hepatitis D with the entry inhibitor myrcludex B: First results of a phase Ib/IIa study. [2018]

3. Netherlands pubmed.ncbi.nlm.nih.gov

First-in-human application of the novel hepatitis B and hepatitis D virus entry inhibitor myrcludex B. [2018]

4. England pubmed.ncbi.nlm.nih.gov

Clinical effects of NTCP-inhibitor myrcludex B. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Early virological response in six patients with hepatitis D virus infection and compensated cirrhosis treated with Bulevirtide in real-life. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Excellent safety and effectiveness of high-dose myrcludex-B monotherapy administered for 48 weeks in HDV-related compensated cirrhosis: A case report of 3 patients. [2020]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Bulevirtide plus Tenofovir Disoproxil Fumarate in Real-World Patients with Chronic Hepatitis B and D Co-Infection. [2023]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Treating hepatitis D with bulevirtide - Real-world experience from 114 patients. [2023]