Novel ultra-potent capsid assembly modulators prevent abnormal accumulation of empty capsids and associated T-cell mediated liver injury in a mouse model of hepatitis B virus infection

patients (88%) but sub-optimally dosed (<13 mg/kg/day) in 1732 (21.5%).Only 197 pts who were under-dosed were documented to have intolerance to higher dosing.Of individuals who were not taking UDCA, only 214 (23%) were referred for alternative/second-line therapy.Of pts taking UDCA for >12 months (n = 7007), 5475 (78%) and 1532 (22%) were classified as low-risk and high risk, respectively, by the contributing hospital.However, on applying the POISE criteria, 663 and 285 patients could be reclassified as 'low-risk and high risk' respectively.Among all who were deemed high-risk with regards disease progression (n = 2476; 29%), 1228 (49.5%) commenced second-line therapy (inc.551 obeticholic acid; 468 bezafibrate; 68 fenofibrate; 76 combination therapy) and 35 referred directly to a transplant centre.In all, 1831 pts were identified as having cirrhosis (22%), of which 1304 (71%) participated in hepatocellular carcinoma surveillance.Features of decompensated liver disease were identified in 272 pts, of which only 46% (n = 67) were discussed with a transplant centre.With regards symptoms/extrahepatic manifestations, n = 3237 and 3690 pts did not undergo any assessment of pruritus (38%) or fatigue (44%) in the 24 months prior to data collection.1803 pts reported ongoing pruritus at the time of assessment, of whom only 1205 (67%) were receiving anti-pruritus therapy. Conclusion:Our study of real-world practice identifies significant gaps in clinical care across the UK PBC population.Potential future strategies to maximise adherence to guideline standards include the implementation of an integrated care pathway, along with key performance indicators, and development of a centralised referral network, allowing equitable and virtual access to specialists for all those living with PBC.