With the latest hepatitis B guidelines and recent phase 3 trial of Bepirovirsen mentioning the utility of quantifying HBsAg levels, how have you incorporated HBsAg in your practice?

Since the first New England journal publication on Bepi (Yuen et al., PMID 36346079), which demonstrated functional cure in patients with less than 1,000 international units of surface antigen, we’ve been quantifying surface antigen in all of our hepatitis B patients. Almost all the large commercial labs do it, so it shouldn’t be an issue, particularly now that Bepe is going to the FDA on October 26. So now would be a good time to start running that test on all your hepatitis B patients as they come in.

I have started sending qHBsAg on patients who might be future candidates for Bepirovirsen. Labcorp and Quest have the test but often entered incorrectly by their check-in clerks. So far, patients with whom I have discussed the Phase 3 BEPI trial have not been that interested in 24 weeks of SQ injections for a 20% chance to stop medication. Most want more long-term safety data.