In the last decade, considerable time and resources have been devoted to hepatitis C research, leading to significant treatment breakthroughs. For hepatitis B, the time may now be at hand to move beyond merely suppressing the virus to uncovering the elusive cure. “Now that they have practically achieved many breakthroughs in hepatitis C, it’s time to shift the attention now to hepatitis B. We still have a lot of ground to cover for hepatitis B in terms of our search for the cure,” said Helen S. Te, MD, FAASLD, who will moderate Monday’s AASLD State-of-the-Art Lecture Hepatitis B Treatment: Current Status and Prospects for Cure.

During the one-hour session, AASLD President Anna S. Lok, MD, FAASLD, one of the world’s foremost authorities on hepatitis B, will review current therapies as well as the potential for new targets for antiviral and immunomodulatory therapies and the initial data to support these approaches.

“I will provide an update of how to manage patients with the current drugs we have, and whether there is any research that may lead to new drugs coming down the pipeline,” said Dr. Lok, the Alice Lohrman Andrews research professor in hepatology, director of clinical hepatology and associate chair for clinical research in the department of internal medicine at the University of Michigan Health System, Ann Arbor.
There are a number of ongoing investigational studies on hepatitis B treatments that target newer areas in the viral replication cycle and pathophysiology. There’s also a new formulation of tenofovir alafenamide (Vemlidy®), which was previously approved for hepatitis B treatment.

“[The new formulation] has more plasma stability and better uptake into the liver, so the dose required is much lower than the previous formulation,” Dr. Lok said. “It has less systemic exposure and fewer side effects on kidneys and the bones. The efficacy is similar but the safety profile better. That’s the one major improvement.”

Although no new drugs have been approved, Dr. Lok said researchers are testing different viral and immune modulation targets. “We hope some of them pan out, which would then offer better options for our patients in the future,” she said.

As to whether uncovering a cure — “the holy grail” in Dr. Te’s terms — is a reasonable expectation, she notes that such a discovery is complicated by the fact that hepatitis B is a DNA virus while hepatitis C is an RNA virus.

Nevertheless, Dr. Lok hopes that a functional cure will be possible in the next 10 years.

“When we talk about a functional cure, what we mean is you treat patients, you suppress the virus, you stop the treatment and the virus does not reactivate. It stays in a dormant state, either because you’ve rendered the virus inactive or you allowed the immune response to recover sufficiently that it is able to permanently suppress the virus,” Dr. Lok said. “Liver damage would stop progressing, and over time you might get some resolution. The risk of liver cancer would be decreased but not necessarily eliminated.”

Dr. Lok said her lecture will address the challenges of hepatitis B research as well as the hope of future advances.

“It’s not that we are not doing any research, but this is a complicated virus and complicated disease,” she said. “Patients and physicians must understand the reasons why there are challenges but also understand that there is hope because we have found better animal models and cell culture models with the ability to develop drugs directed against multiple targets, and being able to use them in combination. We do feel optimistic that we will get to the next stage in the next few years.”

Please refer to the DDW Mobile App or the Program section in Monday’s DDW Daily News for additional details on this and other DDW^® events.