Weekly or Monthly? Fitting Brelovitug Into Hepatitis D Practice

The broad population enrolled in the phase 3 AZURE-1 trial of brelovitug, including participants with cirrhosis, portal hypertension, and HIV coinfection, mirrors the patients clinicians treat for chronic hepatitis D, according to Tatyana Kushner, MD, MSCE, who presented the late-breaking data at The Liver Meeting 2026 in Denver, Colorado.

“Having this type of patient population really helps us have comfort in being able to prescribe this regimen to a patient population that we see in our practice,” Kushner, associate professor of medicine in the Department of Gastroenterology at Weill Cornell Medicine in New York, New York, told HCPLive.

How Could Brelovitug Fit Into Practice?

In AZURE-1, 41% of participants had cirrhosis and 20% had at least probable clinically significant portal hypertension, with no eligibility limits on liver stiffness, bilirubin, or upper ALT. Brelovitug, an investigational monoclonal antibody targeting hepatitis B surface antigen, met the primary end point with both 300 mg weekly at-home dosing and 900 mg monthly in-clinic dosing.¹

Kushner says patient preference may guide the choice of regimen. Some patients are hesitant to self-inject, while others, including those already using weekly glucagon-like peptide-1 receptor agonists, may prefer a weekly routine.

What Questions Remain?

With bulevirtide (Hepcludex) approved in May 2026 as the first US treatment for hepatitis delta virus and several phase 3 trials underway, Kushner calls this “a very exciting time.”² Follow-up in AZURE-1 continues through week 96.¹ Still, she says clinicians will need to learn which patients respond best to each therapy, whether responses are durable after stopping treatment, and whether virologic gains translate into fewer cases of decompensation, liver cancer, and transplant.

Watch the full interview to hear Kushner discuss how multiple emerging therapies may be compared and why patient-reported outcomes deserve more attention.

Editors’ note: Kushner has relevant disclosures with Gilead, GSK, Madrigal, Ipsen, Mirum, and Eiger Biopharmaceuticals.

References

1. Kushner T, Yardeni D, Dobryanska M, et al. Efficacy and safety of brelovitug monotherapy for chronic hepatitis D: primary 24-week results from the phase 3 AZURE-1 study. Late-breaking abstract presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.
2. Campbell P. Bulevirtide receives historic first FDA approval for chronic hepatitis delta. HCPLive. May 22, 2026. Accessed November 11, 2026. https://www.hcplive.com/view/bulevirtide-historic-first-fda-approval-chronic-hepatitis-delta