Elliot Tapper

Hepatologist @michiganliver @vaannarbor; #cirrhosis; encephalopathy; frailty; quality improvement; father; husband. #livertwitter Co-EIC of @HepCommJournal

[Elliot Tapper @ebtapper]

@helpatologist @UHS_LiverTeam @NEndoscopy @MitraVikramjit @BilalMohammadMD @AntonioFaccior6 @ealjahdli @AhmadBazarbashi @LumirKunovsky @AnandVKulkarni2 @Samir_Grover I am glad you are asking this question

If you look at the data, you can see that all of the patients you tested were unlikely to have portal hypertension. The test did not reclassify risk.

[Elliot Tapper @ebtapper]

Why does upper GI bleeding trigger hepatic encephalopathy?

Because 🩸proteins lack BCAAs!
Nutritionally useless!
So they massively spike ammonia generation in the gut.

Even wilder...if you infuse isoleucine, you fix the problem.
See: https://t.co/MmRO7bBdb7 #livertwitter

[Elliot Tapper @ebtapper]

Key point

We can also learn a lot about care delivery in the US from a trial that works in that environment

[Mark Sonderup @mark_sonderup]

@ebtapper Also at TLM26 is that of the of the many new investigational agents & the many hundreds of involved participants almost (1) ALL are likely genotype C HBV and (2) not a single patient site involved from sub Saharan Africa despite 68% of all new infections there. Needs to change.

[Elliot Tapper @ebtapper]

I enjoyed learning more about #hbv at TLM

To me a few highlights

1. Bepi is here. This is the beginning of a new era. Build a team locally
2. The immunology of hbv is wild (good flares! Covid vax and sAg!)
3. What is Pre-genomic RNA!? Get to know it!

[Med-IQ @MedIQCME]

Thank you to @ebtapper for his live updates on the latest HBV research from #TLM26 this past weekend! Check out this thread for highlights.
#MedlQTLM26

[Elliot Tapper @ebtapper]

Phase 3 AZURE-1 from @TatyanaKushner
brelovitug (anti-HBsAg mAb) for hepatitis delta. Combined response at Wk24: 56% weekly 300 mg, 45% monthly 900 mg, 0% delayed
treatment (n=153; 41% cirrhosis). No drug-related SAEs. #MedlQTLM26 #HBV #HDV #TLM26

[Elliot Tapper @ebtapper]

Did COVID-19 vaccines help out with HBV?

In 59,946 Korean adults with hep B, HBsAg loss jumped 56% at the Nov 2021 rollout (IRR 1.56, 1.26–1.93), then plateaued/faded. HCC (control) didn't budge. Population-level timing only: needs patient-level data!!! #MedlQTLM26 #HBV #tlm26

[Elliot Tapper @ebtapper]

Good flares? The immune system is a frienemy!

ALT flares on bepi in the B-Well trials (ALT =3x baseline) had faster, deeper HBsAg decline, and most functional-cure responders had one.

#MedlQTLM26 #HBV

[Vinay Jahagirdar @vinayjaha]

Steroids in alc hep - less is more 💊

Congrats to @AnandVKulkarni2 and team on this important late breaker!
STASH 2 RCT: 7-d or 14-d prednisolone comparable to tapering 30-d course in severe alc hep

@AASLDtweets @AASLDFoundation #TLM2026 @RoyAHep @manasa_alla @giri_gutnliver @LiverFellow @INASL_Liver

[Anand V Kulkarni @AnandVKulkarni2]

Less is more in Alc hep STASH II on shorter duration of pred 14 days is okay enough. @ruben_hernaez @juanpabloarab @RoyAHep #TLM26 @AASLDtweets @LiverFellow @ebtapper @GlobalAlcHep @AlchepUK @ACERjournal @BlaneyMD @JenLaiLiverDoc

[Elliot Tapper @ebtapper]

Fantastic work!
Why 30 days of 40mg of prednisone for alcohol-associated hepatitis?

That duration has never been questioned - until now

@AnandVKulkarni2 returns to compare 7 vs 14 days and this study is gold

#tlm26

[Akash Roy @RoyAHep]

Recompensation Expanded and Clarified
Amazing deliberation by @ReibergerThomas
@AASLDtweets
@AASLDFoundation
#TLM2026

[Akash Roy @RoyAHep]

An @ebtapper masterclass on what not to research and how to delve forward in future
#tlm26 @AASLDtweets @AASLDFoundation

[Lily Dara @lilydaramd]

Thank you to @AASLDtweets ❤️ I am so humbled and wholeheartedly agree with @JenLaiLiverDoc ❤️ The true honor is to be recognized next to this group of amazing liver scientists, friends, and colleagues @KeckMedicineUSC @USC_KeckGILiver @AASLDFoundation @norahterrault

[Elliot Tapper @ebtapper]

Treat HBV with normal ALT (<40 U/L)?

PROMOTE randomized 193 such pts to Tenofovir amibufenamide (TMF) vs no treatment: 82% on TMF had HBV DNA <20 IU/mL at Wk144, and 9 untreated controls progressed to meet treatment criteria.
#MedlQTLM26
#HBV

[Elliot Tapper @ebtapper]

Repurposing a prevention vaccine as therapy?

Phase 1: 2 doses of TLR9-adjuvanted HbSag (HEPLISAV-B_ in 10 NUC-treated pts with HBV were safe, HBsAg fell modestly (0.1–0.5 log) in 8, and anti-HBs rose in 2. #MedlQTLM26 #HBV

[Elliot Tapper @ebtapper]

Hep B treatment is getting cool
Meet SA1211. It silences HBV transcripts AND PD-L1.
Phase 1 trial: 150 mg x3 doses lowered HBsAg 0.73 log by Wk8, and exhausted CD8+ subsets fell 37–70%.
#MedlQTLM26 #HBV

[Elliot Tapper @ebtapper]

Good flares? The immune system is a frienemy!

ALT flares on bepi in the B-Well trials (ALT =3x baseline) had faster, deeper HBsAg decline, and most functional-cure responders had one.

#MedlQTLM26 #HBV

[Elliot Tapper @ebtapper]

Can lowering viral antigen wake up HBV immunity?
After 96 wks of Pevifoscorvir (ALG-000184), a capsid assembly modulator (CAM-E), HBeAg+ pts showed less T/NK-cell exhaustion, fewer Tregs and detectable HBV-specific T cells.
#MedlQTLM26
#HBV

[Elliot Tapper @ebtapper]

Who responds to bepi?
In 1,776 B-Well pts, low baseline HBsAg was the strongest predictor of functional cure (OR 0.12 per log). Younger age, female sex, HBeAg-neg status and genotype A also helped.
#MedlQTLM26 #HBV

[Elliot Tapper @ebtapper]

Did COVID-19 vaccines help out with HBV?

In 59,946 Korean adults with hep B, HBsAg loss jumped 56% at the Nov 2021 rollout (IRR 1.56, 1.26–1.93), then plateaued/faded. HCC (control) didn't budge. Population-level timing only: needs patient-level data!!! #MedlQTLM26 #HBV #tlm26