Clinical cure of hepatitis B has been a hot topic in the field of viral hepatitis, and the 58th Annual Meeting of the European Association for the Study of the Liver (EASL 2023) and the 2023 EASL Congress unveiled numerous advancements in new drug research. Dr. Chao Wu and his team from the Department of Infectious Diseases at the Affiliated Drum Tower Hospital of Nanjing Medical University have been engaged in both clinical and basic research on viral hepatitis. In the 2023 EASL Congress, their team contributed 14 research findings, with three of them receiving the Young Investigator Awards. Hepatology Digest invited Dr. Chao Wu to discuss the current state of clinical cure for hepatitis B and analyze future prospects, as well as his thoughts on the overall development of liver diseases.
Hepatology Digest: What are the primary strategies for achieving clinical cure in chronic hepatitis B, and what insights have the developments presented at this year’s EASL Congress offered? What strategies do you foresee for the future?
Dr. Chao Wu: In China, a significant amount of work has already been conducted on clinical cure, with over 30,000 patients included in the “Zhufeng” project. Some of the publicly available data show promising treatment outcomes. Therefore, clinical cure is undoubtedly the most crucial goal for hepatitis B prevention and control in the future. However, we face several challenges.
Firstly, China has a vast population of chronic hepatitis B (CHB) patients, with over 80 million HBV-infected individuals, but only about a quarter of them may require treatment. As treatment guidelines evolve, the population requiring treatment continues to expand. However, the proportion of CHB patients who can benefit from clinical cure or achieve viral immune control is not particularly high among the total CHB population. It’s a significant challenge to ensure that non-privileged individuals can attain clinical cure.
Secondly, the clinical cure rate among privileged individuals can reach 30% to 40%, and it may increase in the future. However, it will never reach 100%. Therefore, we look forward to the development of new treatments or drug combinations that can achieve higher cure rates within a limited treatment period, aiming for at least 95% or 99%. This is necessary to achieve the goal of clinical cure for hepatitis B and the World Health Organization’s target to eliminate the public health threat of viral hepatitis by 2030.
To address this, Chinese experts have initiated exploration of clinical cure for hepatitis B in various fields and patient groups. We hope to find the best approach to clinical cure from different perspectives and different patient populations, including research on infants, pregnant women, and immune-tolerant individuals. Our hospital leads the first large-scale real-world study in China for “uncertain phase” hepatitis B patients, known as the “Navigation” project. This prospective, multicenter, observational cohort study aims to evaluate the long-term prognosis and the effectiveness and safety of antiviral therapy in patients with chronic HBV infection who have HBsAg > 1000 IU/mL, are HBeAg negative, have normal ALT, and have HBV DNA > 2000 IU/mL.
During this EASL Congress, Professor Wen-Hong Zhang’s team from Huashan Hospital, Fudan University, presented the latest research results on the “OASIS” project [15]. As one of the largest prospective studies for chronic hepatitis B in Asia, preliminary data from this stage demonstrated that interferon therapy is effective in achieving clinical cure in some chronic hepatitis B patients. Not all patients achieve clinical cure after interferon therapy, but it can shorten the journey to clinical cure, much like a sprint in the latter part of a mountain climb. Therefore, clinical cure is undoubtedly the trend in the future of hepatitis B treatment, with the goal of eliminating the hepatitis B virus. The time required may vary among different patients, but as clinical physicians, we have great confidence in this.
As mentioned earlier, our team has also conducted some work on clinical cure for hepatitis B, focusing on a crucial step—antibody production. Restoring B cell function and antibody production is a critical aspect of clinical cure. We have participated in two studies related to B cells and found a close relationship between B cell function and clinical cure in individuals who produce antibodies specifically targeting HBsAg. We hope to delve deeper into this aspect in the future.
Furthermore, although there were not many large-sample studies on clinical cure for hepatitis B announced at this EASL Congress, new drug developments have brought a lot of hope. Several new drugs have entered phase II and phase III clinical trials, including research on new drugs and interferon therapy conducted by teams in Hong Kong, China, as well as studies on new drugs by pharmaceutical companies, all of which have shown excellent efficacy. Importantly, many companies are conducting combination therapy trials, accelerating the exploration of new drug combinations, including new drugs combined with new drugs and new drugs combined with existing drugs. So, we now have at least four or five handy “weapons.”
Overall, achieving clinical cure for hepatitis B in the future will require combinations of various drugs, tailored to different patient characteristics and states. The road ahead is still challenging, but it is filled with hope. Let us look forward to more data and results.
Hepatology Digest: In addition to hepatitis B cure, could you please talk about other topics or research at this year’s EASL Congress that you found interesting? And how did you feel about attending this conference?
Dr. Chao Wu: This year’s EASL Congress was indeed impressive.
Firstly, it was not only attended by clinical doctors but also by nursing teams and patient groups. Multiple international liver disease patient organizations were involved. In Europe and other regions, fatty liver, alcoholic liver disease, and some rare liver diseases pose significant risks. The conference focused on the theme “Love Your Liver” and carried out extensive public education, even extending to student groups. In China, as a major hepatitis B country, we have placed significant emphasis on hepatitis B research, which may have overshadowed other areas of study. However, with changes in people’s lifestyles, the spectrum of liver diseases is also changing. It is not enough to focus solely on hepatitis B, and we should also conduct research in conjunction with fatty liver disease. Many teams in China, including ours, have conducted research on hepatitis B combined with fatty liver disease.
Secondly, what left a deep impression on me was the presentation of several studies on anti-discrimination and the psychological status of patients at this conference. These thoughts and concepts are more advanced than just focusing on “treating the disease.” In our medical practice, we should advocate the “patient-first” principle, emphasizing not only “treating the disease” but also “treating the person.” In the field of liver diseases, I believe our vision should be broader in the future, and we should also focus on patient education, organize medical teams, prioritize patients, and provide comprehensive management and care.
Tag: EASL2023,Voice of China,CHB,HBV
