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HBV and HDV management EASL 2025
Advances in HBV/HDV Management: Top Data From EASL 2025

Released: June 06, 2025

Expiration: June 05, 2026

Maria Buti
Maria Buti, MD
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Key Takeaways
  • With advancements in the management of HBV and HDV, international guidelines have been updated to reflect expanded treatment eligibility and simplified algorithms.
  • Data on emerging novel therapies presented at EASL Congress 2025—both monotherapies and combination regimens—suggest efficacy and safety in HBV and HDV.

Recent clinical studies have significantly advanced our understanding and management of patients with chronic hepatitis B virus (HBV) and hepatitis D virus (HDV) infection. Furthermore, these studies have informed new treatment paradigms and international guideline updates. Both EASL and WHO have revised their HBV guidelines by expanding treatment eligibility criteria and simplifying algorithms. These changes are grounded in alanine transaminase (ALT) levels, HBV DNA, and noninvasive fibrosis assessment (eg, liver stiffness measurement, Fibrosis-4, FibroTest) and represent a critical shift that will allow a greater proportion of patients to benefit from antiviral therapy.

Emerging Novel Therapies for HBV/HDV
Several promising HBV and HDV treatment strategies were highlighted at EASL Congress 2025. One phase II study explored the effect of adjuvant peginterferon (pegIFN) on HBV functional cure. In patients without cirrhosis on long-term nucleos(t)ide analogue (NUC) therapy, cessation NUC therapy followed by a 16-week course of pegIFN showed potential in increasing hepatitis B surface antigen (HBsAg) loss rates and mitigating the risk of exaggerated ALT flares, particularly among those with low HBsAg levels.

The development of novel agents for HBV treatment also continues to progress. AHB-137, an antisense oligonucleotide, demonstrated a favorable safety profile and HBsAg reduction in patients with baseline antigen levels 100-3000 IU/mL. ALG-000184, a capsid assembly modulator, exhibited a strong antiviral effect and encouraging  hepatitis B e antigen (HBeAg) seroconversion rates as monotherapy and in combination with entecavir in previously untreated patients.

In addition to these therapies, combination regimens for HBV are gaining momentum. The combination of imdusiran, a small interfering RNA, plus the immunotherapeutic VTP-300 showed greater HBsAg loss than use of either agent alone.

In the evolving HDV landscape, several notable therapeutic options were presented at EASL Congress 2025. The first is bulevirtide, which is approved by the European Medicines Agency to treat chronic HDV infection in people 3 years of age or older. It continues to demonstrate effectiveness in real-world settings, as data from the SAVE-D cohort support the durability of HDV RNA suppression with ongoing bulevirtide therapy. Combination therapy with bulevirtide and pegIFN was associated with higher virologic response and lower relapse rates than bulevirtide monotherapy at 48 weeks of follow-up. Therapies like the monoclonal antibody tobevibart (VIR-3434), used alone or with the small interfering RNA elebsiran (VIR-2218), showed rapid reductions in HDV RNA and ALT levels, offering future promise in treating chronic HDV infection.

Future Directions in HBV/HDV Management
As the therapeutic landscape for HBV and HDV continues to expand, healthcare professionals must remain proactive in understanding and adopting evolving treatment approaches that optimize patient outcomes. With the advent of novel treatments and ever-changing guidelines, we are entering a new era in hepatitis management: one that brings us closer to the goal of curing HBV.

Your Thoughts
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