Overview

Hepcludex is an antiviral medicine used to treat chronic (long-term) hepatitis delta virus (HDV) infection in adults with compensated liver disease (when the liver is damaged but is still able to work), when the presence of viral RNA (genetic material) has been confirmed by blood tests.

HDV is an 'incomplete' virus, because it cannot replicate in cells without the help of another virus, the hepatitis B virus. Because of this, patients infected with the virus always also have hepatitis B.

HDV infection is rare, and Hepcludex was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 19 June 2015. Further information on the orphan designation can be found on the EMA website.

Hepcludex contains the active substance bulevirtide.

Hepcludex can only be obtained with a prescription and treatment should be started only by a doctor experienced in the management of patients with HDV infection.

The medicine is available as an injection to be given under the skin. It can be given on its own, or in combination with a ‘nucleoside/nucleotide analogue’ medicine for the treatment of the underlying hepatitis B infection. Treatment should continue for as long as the patient benefits from it.

For more information about using Hepcludex, see the package leaflet or contact your doctor or pharmacist.

The active substance in Hepcludex, bulevirtide, works by attaching to and blocking a receptor (target) through which the hepatitis delta and hepatitis B viruses enter liver cells. By blocking the entry of the virus into the cells, Hepcludex limits the ability of HDV to replicate, preventing the spread of the virus in the liver and thereby reducing inflammation.

Two main studies showed that Hepcludex was effective at clearing all or 99% of the HDV genetic material (RNA) from the blood.

In the first study, 55 out of 90 patients treated with Hepcludex plus tenofovir (a medicine for hepatitis B) had substantial reductions in HDV replication after 6 months, compared with 1 out of 28 patients given tenofovir alone. Patients treated with Hepcludex also showed a reduction in the blood levels of the liver enzyme ALT, indicating an improvement of liver disease. 

Similar results were seen in the second study where 8 out of 15 patients given Hepcludex plus peginterferon alfa (another medicine for hepatitis B) for 48 weeks no longer had detectable levels of HDV RNA 6 months after their treatment. Of the 15 patients treated with Hepcludex alone, one no longer had detectable levels of HDV RNA. Of the 15 patients treated with peginterferon alfa alone, no patient achieved this result.

In a larger, confirmatory study in 150 patients, 45% (22 out of 49) of patients given a low dose of Hepcludex and 48% (24 out of 50) of patients given a higher dose of Hepcludex had almost all of their HDV RNA cleared after 48 weeks, compared with 2% (1 out of 51) of untreated patients.

For the full list of side effects and restrictions of Hepcludex, see the package leaflet.

The most common side effects with Hepcludex (which may affect more than 1 in 10 people) include raised levels of bile salts in the blood, headache, itching and reactions at the site of injection. 

The most common serious side effect is a flare-up of liver inflammation after stopping Hepcludex.

Available data have shown a beneficial effect of Hepcludex on viral replication and liver inflammation in patients with HDV infection. As for its safety, the side effects seen with Hepcludex were considered acceptable.

The European Medicines Agency therefore decided that Hepcludex’s benefits are greater than its risks and it can be authorised for use in the EU.

Hepcludex was originally given ‘conditional authorisation’ because there was more evidence to come about the medicine. The company has since provided comprehensive information confirming the findings from earlier studies. As a result, the conditional authorisation has been switched to a standard one.

Since Hepcludex has been given conditional authorisation, the company that markets Hepcludex will collect data on the use of the medicine in a patient registry and will provide the final results from two ongoing studies. 

Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Hepcludex have been included in the summary of product characteristics and the package leaflet.

As for all medicines, data on the use of Hepcludex are continuously monitored. Side effects reported with Hepcludex are carefully evaluated and any necessary action taken to protect patients.

Hepcludex received a conditional marketing authorisation valid throughout the EU on 31 July 2020. The conditional marketing authorisation was switched to a standard marketing authorisation on 18.07.2023

This overview was last updated in 05-2023.

Hepcludex : EPAR - Medicine overview

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Hepcludex : EPAR - Risk-management-plan summary

Product information

Hepcludex : EPAR - Product information

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Latest procedure affecting product information: II/0019

18/07/2023

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This medicine’s product information is available in all official EU languages.
Select 'available languages' to access the language you need.

Product information documents contain:

  • summary of product characteristics (annex I);
  • manufacturing authorisation holder responsible for batch release (annex IIA);
  • conditions of the marketing authorisation (annex IIB);
  • labelling (annex IIIA);
  • package leaflet (annex IIIB).

Hepcludex : EPAR - All authorised presentations

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magyar (HU) (59.53 KB - PDF)
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svenska (SV) (51.62 KB - PDF)

Product details

Name of medicine
Hepcludex
Active substance
Bulevirtide acetate
International non-proprietary name (INN) or common name
bulevirtide
Therapeutic area (MeSH)
Hepatitis D, Chronic
Anatomical therapeutic chemical (ATC) code
J05A

Pharmacotherapeutic group

Antivirals for systemic use

Therapeutic indication

Hepcludex is indicated for the treatment of chronic hepatitis delta virus (HDV) infection in plasma (or serum) HDV-RNA positive adult patients with compensated liver disease.

Authorisation details

EMA product number
EMEA/H/C/004854

Additional monitoring

This medicine is under additional monitoring, meaning that it is monitored even more intensively than other medicines. For more information, see Medicines under additional monitoring.

Orphan

This medicine was designated an orphan medicine. This means that it was developed for use against a rare, life-threatening or chronically debilitating condition or, for economic reasons, it would be unlikely to have been developed without incentives. For more information, see Orphan designation.

Marketing authorisation holder
Gilead Sciences Ireland UC

Carrigtohill
County Cork T45 DP77
Ireland

Marketing authorisation issued
31/07/2020
Revision
11

Assessment history

Hepcludex : EPAR - Procedural steps taken and scientific information after authorisation

Hepcludex-H-C-004854-P46-005 : EPAR - Assessment report

Hepcludex-H-C-004854-II-0019 : EPAR - Assessment report - variation

Hepcludex : Orphan maintenance assessment report

Hepcludex : EPAR - Public assessment report

CHMP summary of positive opinion for Hepcludex

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