{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:26:25Z","timestamp":1782491185885,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bulevirtide (BLV) is the only approved therapy for chronic hepatitis D (CHD) and compensated liver disease. Daily subcutaneous injection and the need for refrigeration may pose challenges, especially in patients with limited language proficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Assessment of patient\u2010reported BLV handling and satisfaction and association with virologic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients receiving BLV were assessed using a structured questionnaire on injection preparation, administration, refrigeration, adverse effects, and language proficiency. Virologic response was defined as complete (\u2265\u20092 log10 reduction from baseline or HDV RNA undetectable), intermediate (\u2265\u20091 log10 but &lt;\u20092 log10 reduction), non\u2010response (&lt;\u20091 log10 reduction or increase), or breakthrough (&gt;\u20091 log10 increase after \u2265\u20092 log10 reduction).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 115 patients from 30 countries were recruited at 12 German centres. German language skills were rated as good, sufficient, poor or absent in 58%, 25% and 17% of cases. Reported difficulties included injection preparation (17%), administration (25%) and refrigeration (27%). Patients without virologic response or with viral breakthrough reported difficulties with injection administration in 56% compared to 17% with intermediate or complete response (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002), while no differences were observed regarding preparation or refrigeration. Injection site reactions occurred in 57% of patients. Overall, 82% were satisfied with the practical handling and 94% with the tolerability of BLV. Good language proficiency was associated with greater satisfaction with the practical handling (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0067), which in turn correlated with virologic response (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BLV administration is generally well manageable. Limited language proficiency and injection difficulties may negatively affect patient satisfaction and potentially influence treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>German Clinical Trials Registry (DRKS 00033153)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70404","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T13:47:11Z","timestamp":1760795231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Handling Perception and Language Barriers on Virologic Response to Daily Subcutaneous Bulevirtide in Hepatitis D"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0401-1140","authenticated-orcid":false,"given":"Toni","family":"Herta","sequence":"first","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Campus Virchow\u2010Klinikum (CVK) and Campus Charit\u00e9 Mitte (CCM) Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Berlin Institute of Health at Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin BIH Biomedical Innovation Academy, BIH Charit\u00e9 Clinician Scientist Program  Berlin Germany"},{"name":"Division of Hepatology, Department of Medicine II Leipzig University Medical Center  Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dietz\u2010Fricke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00fcnevver","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Campus Virchow\u2010Klinikum (CVK) and Campus Charit\u00e9 Mitte (CCM) Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Sprinzl","sequence":"additional","affiliation":[{"name":"Goethe University Frankfurt, University Hospital  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai\u2010Henrik","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B University Hospital Muenster  Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-0962","authenticated-orcid":false,"given":"Julia M.","family":"Grottenthaler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics University Hospital Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Buggisch","sequence":"additional","affiliation":[{"name":"Ifi\u2010Institute for Interdisciplinary Medicine  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang Maximilian","family":"Kremer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I University Medical Center of the Johannes Gutenberg\u2010University  Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian P.","family":"Reiter","sequence":"additional","affiliation":[{"name":"University Hospital W\u00fcrzburg Division of Hepatology, Dept. of Medicine II  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Geier","sequence":"additional","affiliation":[{"name":"University Hospital W\u00fcrzburg Division of Hepatology, Dept. of Medicine II  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6752-0690","authenticated-orcid":false,"given":"Christoph","family":"Schramm","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta","family":"Merle","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV University of Heidelberg  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Neumann\u2010Haefelin","sequence":"additional","affiliation":[{"name":"Department of Medicine II, University Medical Centre Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"},{"name":"Department of Gastroenterology and Hepatology University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-0226","authenticated-orcid":false,"given":"Frank","family":"Tacke","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Campus Virchow\u2010Klinikum (CVK) and Campus Charit\u00e9 Mitte (CCM) Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berg","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Medicine II Leipzig University Medical Center  Leipzig 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