{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:35:00Z","timestamp":1784543700950,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Treatment of chronic hepatitis delta virus (HDV) infection with pegylated interferon\u2010alpha (PEG\u2010IFN\u2010alpha) is associated with variable and often poor treatment responses. Recently, bulevirtide was approved for chronic HDV infection with promising results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a pairwise network meta\u2010analysis of five treatment regimens\u2014bulevirtide, bulevirtide plus PEG\u2010IFN\u2010alpha, PEG\u2010IFN\u2010alpha, lonafarnib and lonafarnib plus PEG\u2010IFN\u2010alpha\u2014by reviewing randomised studies in PubMed, EMBASE and Web of Science. A control group receiving no treatment or nucleos(t)ide analogs alone was included. Primary outcomes were virological response (undetectable HDV RNA or \u2265\u20092 log\n                      <jats:sub>10<\/jats:sub>\n                      IU\/mL decrease from baseline), biochemical response (ALT normalisation) and combined response (defined as fulfilment of both virological and biochemical responses), measured at end of treatment and 24\u2009weeks post\u2010treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were used for analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 934 patients in 6 randomised studies showed that, at the end of treatment, bulevirtide plus PEG\u2010IFN\u2010alpha combination therapy was more likely to achieve virological response compared to PEG\u2010IFN\u2010alpha (OR, 8.39; 95% CI: 3.46, 20.37) and bulevirtide (OR, 6.31; 95% CI: 3.17, 12.59). Bulevirtide 10\u2009mg plus PEG\u2010IFN\u2010alpha combination therapy was more likely to achieve virological response compared to bulevirtide 2\u2009mg plus PEG\u2010IFN\u2010alpha combination therapy at the end of treatment (OR, 2.43; 95% CI: 1.16, 5.09). Bulevirtide 10\u2009mg (OR, 4.43; 95% CI: 1.17, 16.83) and bulevirtide 2\u2009mg (OR, 10.95; 95% CI: 2.51, 47.74) were more likely to achieve biochemical response compared to PEG\u2010IFN\u2010alpha at the end of treatment, but bulevirtide plus PEG\u2010IFN\u2010alpha combination therapy was not (OR, 3.24; 95% CI: 0.84, 12.50). At 24\u2009weeks post\u2010treatment, bulevirtide plus PEG\u2010IFN\u2010alpha combination therapy was more likely to result in virological response compared to PEG\u2010IFN\u2010alpha (OR, 3.69; 95% CI: 1.05, 12.98) and bulevirtide (OR, 2.79; 95% CI: 1.13, 6.92), as well as biochemical response compared to PEG\u2010IFN\u2010alpha (OR, 3.23; 95% CI: 1.38, 7.56). Bulevirtide plus PEG\u2010IFN\u2010alpha combination therapy was more likely to result in combined response compared to PEG\u2010IFN\u2010alpha (OR, 6.06; 95% CI: 2.03, 18.05) and bulevirtide (OR, 4.67; 95% CI: 2.21, 9.85) at the end of treatment. At 24\u2009weeks post\u2010treatment, neither bulevirtide monotherapy nor bulevirtide plus PEG\u2010IFN\u2010alpha combination therapies at various doses were more likely to achieve combined response compared to PEG\u2010IFN\u2010alpha.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bulevirtide plus PEG\u2010IFN\u2010alpha combination therapy was superior in achieving virological response, both in magnitude and duration, compared to bulevirtide or PEG\u2010IFN\u2010alpha monotherapies in patients with chronic HDV infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70232","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T03:29:17Z","timestamp":1752722957000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Efficacy of Treatment Regimens for Chronic Hepatitis D Virus Infection: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1111","volume":"45","author":[{"given":"Konstantinos","family":"Ouranos","sequence":"first","affiliation":[{"name":"Department of Medicine Houston Methodist Research Institute  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia K.","family":"Mylona","sequence":"additional","affiliation":[{"name":"Department of Medicine Houston Methodist Research Institute  Houston Texas USA"},{"name":"School of Rural, Surveying and Geoinformatics Engineering National Technical University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charilaos","family":"Dellis","sequence":"additional","affiliation":[{"name":"Department of Medicine Houston Methodist Research Institute  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra 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