Emerging Therapies for Chronic Hepatitis B and the Potential for a Functional Cure

Ming Ling Chang, Yun Fan Liaw*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

6 Scopus citations

Abstract

Worldwide, an estimated 296 million people are living with chronic hepatitis B virus (HBV) infection, with a significant risk of morbidity and mortality. Current therapy with pegylated interferon (Peg-IFN) and indefinite or finite therapy with nucleoside/nucleotide analogues (Nucs) are effective in HBV suppression, hepatitis resolution, and prevention of disease progression. However, few achieve hepatitis B surface antigen (HBsAg) loss (functional cure), and relapse often occurs after the end of therapy (EOT) because these agents have no direct effect on durable template: covalently closed circular DNA (cccDNA) and integrated HBV DNA. Hepatitis B surface antigen loss rate increases slightly by adding or switching to Peg-IFN in Nuc-treated patients and this loss rate greatly increases up to 39% in 5 years with finite Nuc therapy with currently available Nuc(s). For this, great effort has been made to develop novel direct-acting antivirals (DAAs) and immunomodulators. Among the DAAs, entry inhibitors and capsid assembly modulators have little effect on reducing HBsAg levels; small interfering RNA, antisense oligonucleotides, and nucleic acid polymers in combination with Peg-IFN and Nuc may reduce HBsAg levels significantly, even a rate of HBsAg loss sustained for > 24 weeks after EOT up to 40%. Novel immunomodulators, including T-cell receptor agonists, check-point inhibitors, therapeutic vaccines, and monoclonal antibodies may restore HBV-specific T-cell response but not sustained HBsAg loss. The safety issues and the durability of HBsAg loss warrant further investigation. Combining agents of different classes has the potential to enhance HBsAg loss. Compounds directly targeting cccDNA would be more effective but are still in the early stage of development. More effort is required to achieve this goal.

Original languageEnglish
Pages (from-to)367-388
Number of pages22
JournalDrugs
Volume83
Issue number5
DOIs
StatePublished - 04 2023

Bibliographical note

© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Keywords

  • Humans
  • Hepatitis B, Chronic/drug therapy
  • Hepatitis B Surface Antigens/genetics
  • Hepatitis B virus/genetics
  • Antiviral Agents/therapeutic use
  • Hepatitis C, Chronic/drug therapy
  • DNA, Circular/pharmacology

Fingerprint

Dive into the research topics of 'Emerging Therapies for Chronic Hepatitis B and the Potential for a Functional Cure'. Together they form a unique fingerprint.

Cite this