A multiscale model of the action of a capsid assembly modulator for the treatment of chronic hepatitis B.

Capsid assembly modulators (CAMs) are a novel class of anti-hepatitis B virus (HBV) treatments in clinical trials. These CAMs have a distinct mechanism of action from nucleos(t)ide analogues and thus represent an attractive option for the treatment of chronic HBV infection. We developed a multiscale model of the intracellular HBV lifecycle and extracellular dynamics using a time-since-infection structured partial differential equation. We fit the model to participant data from a recent phase I trial, performed a detailed parameter sensitivity analysis, identified key mechanisms driving viral response to first-generation CAM treatment, and demonstrated that HBV RNA is more sensitive than HBV DNA to changes in CAM efficacy, highlighting the potential role of HBV RNA as a biomarker for CAM effectiveness.