The recently published bepirovirsen phase 3 trial introduces several important clinical considerations for hepatitis B treatment. First, this antisense oligonucleotide represents a mechanistically distinct approach from existing therapies, targeting viral RNA production rather than simply suppressing replication. This innovation addresses a fundamental limitation of current nucleoside analogues: their failure to achieve hepatitis B surface antigen loss, despite effective viral suppression.
Second, the trial’s primary endpoints—sustained HBsAg loss and undetectable HBV DNA—align directly with WHO definitions of functional cure, moving treatment beyond indefinite viral suppression toward potential disease resolution. Third, with 296 million people globally requiring improved treatment options, bepirovirsen offers clinicians a novel tool for patients who may have limited response or tolerability concerns with conventional therapies. These developments signal meaningful progress toward functional cure as an achievable clinical goal rather than a theoretical possibility.
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