Chronic Hepatitis D Infection
Conditions
Brief summary
An Open-label, Dose-ranging Study to Evaluate the Safety and Efficacy of Lonafarnib with Ritonavir Boosting +/- Peginterferon alfa-2a in Patients Chronically Infected with Delta Hepatitis (HDV) (LOWR-2).
Detailed description
Chronic delta hepatitis is a serious form of chronic liver disease caused by infection with the hepatitis D virus (HDV), a small RNA virus that requires farnesylation of its major structural protein (HDV antigen) for replication. Up to sixty subjects with chronic delta hepatitis will be randomized to receive one of ten different doses of lonafarnib. Dosing will occur over 12-48 weeks, and during that time, evidence of antiviral response will be assessed by frequent measurements of HDV-RNA. The primary therapeutic endpoint will be an improvement in quantitative serum HDV RNA levels after treatment with lonafarnib therapy. The primary safety endpoint will be the ability to tolerate the drug at the prescribed dose for the treatment duration. Several secondary endpoints will be measured, including side effects, ALT levels, and symptoms. Therapy will be stopped for intolerance to lonafarnib. This study is designed as a Phase 2a study assessing the safety, tolerance and antiviral activity of nine dosing combinations of lonafarnib with ritonavir boosting with and without peginterferon alfa-2a (PEG IFN-a).
Interventions
DRUGlonafarnib
antiviral farnesyl transferase inhibitor
DRUGritonavir
CYP 3A4 inhibitor, lonafarnib booster
immunomodulator
Sponsors
Ankara University
Eiger BioPharmaceuticals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Males or females, 18 to 65 years of age who are diagnosed with HDV by PCR * Chronic hepatitis D infection, genotype 1, documented by a positive anti-HDV Ab test at least of 6 months duration and detectable HDV RNA by PCR within 3 months to study entry * Liver biopsy within the last two years (biopsy can be done at the Screening Visit) * Positive viral load of \>100,000 copies/mL as measured by quantitative PCR * Electrocardiogram (ECG) shows no acute ischemia or clinically significant abnormality and a QT/QTc interval \<450 milliseconds - using Bazett's correction * Females of childbearing potential (intact uterus and within 1 year since the last menstrual period) should be non-lactating and have a negative serum pregnancy test. In addition, these subjects should agree to use one of the following acceptable birth control methods throughout the study: 1. abstinence 2. surgical sterilization (bilateral tubal ligation, hysterectomy, bilateral oophorectomy) six months minimum 3. IUD in place for at least six months 4. barrier methods (condom or diaphragm) with spermicide 5. surgical sterilization of the partner (vasectomy for six months) 6. hormonal contraceptives for at least three months prior to the first dose of study drug * Willing and able to comply with study procedures and provide written informed consent
Exclusion criteria
* Participation in a clinical trial with or use of any investigational agent within 30 days of Study Visit 1 * Patients co-infected with HIV * Patients with screening tests positive for HCV, or anti-HIV Ab * History of decompensated cirrhosis within the past year * Active jaundice defined by total bilirubin \> 2.0 excluding Gilbert's disease * INR ≥ 1.5 * Eating disorder or alcohol abuse within the past 2 years, excessive alcohol intake (\> 20 g per day for females (1.5 standard alcohol drinks) or \> 30 g per day for males (2.0 standard alcohol drinks) (a standard drink contains 14 g of alcohol: 12 oz of beer, 5 oz of wine or 1.5 oz of spirits) (1.0 fluid oz (US) = 29.57 mL) * Drug abuse within the last six months with the exception of cannabinoids and their derivatives * Patients with absolute neutrophil count (ANC) \< 1500 cells/mm\^3; platelet count \< 100,000 cells/mm\^3; hemoglobin \< 12 g/dL for women and \< 13 g/dL for men; abnormal TSH,T4, or T3 or thyroid function not adequately controlled; or serum creatinine concentration ≥ 1.5 times upper limit of normal (ULN) * History or clinical evidence of any of the following: 1. variceal bleeding, ascites, hepatic encephalopathy, CTP score \> 6, decompensated liver disease or any other form of non-viral hepatitis 2. immunologically mediated disease (e.g., rheumatoid arthritis, inflammatory bowel disease, severe psoriasis, systemic lupus erythematosus) requiring more than intermittent nonsteroidal anti-inflammatory medications for management or that requires frequent or prolonged use of corticosteroids (inhaled asthma medications are allowed) 3. any malignancy within 3 years except for basal cell skin cancer 4. significant or unstable cardiac disease (e.g., angina, congestive heart failure, uncontrolled hypertension, history of arrhythmia) 5. chronic pulmonary disease (e.g., chronic obstructive pulmonary disease) associated with functional impairment 6. severe or uncontrolled psychiatric disease, including severe depression, history of suicidal ideation, suicidal attempts or psychosis requiring medication and/or hospitalization 2 * Patients with a body mass index \> 30 kg/m\^2 * Concomitant drugs known to prolong the QT interval
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 12-48 weeks | Proportion of intent to treat patients with ≥2 log10 decline of HDV RNA from baseline at end of treatment (EOT) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| < LLOQ in HDV RNA at End of Treatment (EOT) | 12-48 weeks | Proportion of intent to treat patients with HDV RNA below the limit of quantitation at end of treatment |
| ALT Normalization at End of Treatment | 12-48 weeks | Proportion of intent to treat population who normalize ALT at end of treatment |
Other
| Measure | Time frame | Description |
|---|---|---|
| Mean HDV RNA Decline | 12-48 weeks | mean HDV RNA decline of intent to treat population from baseline to end of treatment |
Countries
Turkey (Türkiye)
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Lonafarnib/Ritonavir - I lonafarnib 100 mg BID + ritonavir 100 mg QD
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 4 |
| Lonafarnib/Ritonavir - II lonafarnib 100 mg BID + ritonavir 50 mg BID
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 4 |
| Lonafarnib/Ritonavir - III lonafarnib 100 mg QD + ritonavir 100 mg QD
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 5 |
| Lonafarnib/Ritonavir - IV lonafarnib 150 mg QD + ritonavir 100 mg QD
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 3 |
| Lonafarnib/Ritonavir - V lonafarnib 75 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW on Week 12
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster
PEG IFN-a: immunomodulator | 3 |
| Lonafarnib/Ritonavir - VI lonafarnib 25 mg BID + ritonavir 100 mg BID
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 6 |
| Lonafarnib/Ritonavir - VII lonafarnib 50 mg BID + ritonavir 100 mg BID
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster | 13 |
| Lonafarnib/Ritonavir/PEG IFN-a - VIII lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW on Week 12
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster
PEG IFN-a: immunomodulator | 5 |
| Lonafarnib/Ritonavir/PEG IFN-a - IX lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster
PEG IFN-a: immunomodulator | 7 |
| Lonafarnib/Ritonavir - X lonafarnib 25 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib: antiviral farnesyl transferase inhibitor
Ritonavir: CYP 3A4 inhibitor, lonafarnib booster
PEG IFN-a: immunomodulator | 5 |
| Total | 55 |
Baseline characteristics
| Characteristic | Lonafarnib/Ritonavir - I | Total | Lonafarnib/Ritonavir - X | Lonafarnib/Ritonavir/PEG IFN-a - IX | Lonafarnib/Ritonavir/PEG IFN-a - VIII | Lonafarnib/Ritonavir - VII | Lonafarnib/Ritonavir - VI | Lonafarnib/Ritonavir - V | Lonafarnib/Ritonavir - IV | Lonafarnib/Ritonavir - III | Lonafarnib/Ritonavir - II |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | 31 years | 50 years | 39 years | 50 years | 39 years | 41 years | 49 years | 59 years | 56 years | 61 years | 51 years |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 4 Participants | 55 Participants | 5 Participants | 7 Participants | 5 Participants | 13 Participants | 6 Participants | 3 Participants | 3 Participants | 5 Participants | 4 Participants |
| Region of Enrollment Turkey | 4 participants | 55 participants | 5 participants | 7 participants | 5 participants | 13 participants | 6 participants | 3 participants | 3 participants | 5 participants | 4 participants |
| Sex: Female, Male Female | 0 Participants | 19 Participants | 2 Participants | 4 Participants | 0 Participants | 6 Participants | 3 Participants | 1 Participants | 0 Participants | 3 Participants | 0 Participants |
| Sex: Female, Male Male | 4 Participants | 36 Participants | 3 Participants | 3 Participants | 5 Participants | 7 Participants | 3 Participants | 2 Participants | 3 Participants | 2 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk | EG009 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 4 | 0 / 4 | 0 / 5 | 0 / 3 | 0 / 3 | 0 / 6 | 0 / 13 | 0 / 5 | 0 / 7 | 0 / 5 |
| other Total, other adverse events | 4 / 4 | 4 / 4 | 5 / 5 | 3 / 3 | 3 / 3 | 6 / 6 | 13 / 13 | 5 / 5 | 7 / 7 | 5 / 5 |
| serious Total, serious adverse events | 0 / 4 | 0 / 4 | 3 / 5 | 0 / 3 | 0 / 3 | 0 / 6 | 2 / 13 | 1 / 5 | 1 / 7 | 1 / 5 |
Outcome results
Primary
≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT)
Proportion of intent to treat patients with ≥2 log10 decline of HDV RNA from baseline at end of treatment (EOT)
Time frame: 12-48 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Lonafarnib/Ritonavir - I | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - II | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 0 Participants |
| Lonafarnib/Ritonavir - III | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - IV | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 0 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - V | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - VI | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - VII | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 5 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - VIII | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 4 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - IX | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 3 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - X | ≥2 log10 Decline of HDV RNA From Baseline at End of Treatment (EOT) | 4 Participants |
Secondary
ALT Normalization at End of Treatment
Proportion of intent to treat population who normalize ALT at end of treatment
Time frame: 12-48 weeks
Population: intent to treat population
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Lonafarnib/Ritonavir - I | ALT Normalization at End of Treatment | 3 Participants |
| Lonafarnib/Ritonavir - II | ALT Normalization at End of Treatment | 1 Participants |
| Lonafarnib/Ritonavir - III | ALT Normalization at End of Treatment | 1 Participants |
| Lonafarnib/Ritonavir - IV | ALT Normalization at End of Treatment | 2 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - V | ALT Normalization at End of Treatment | 0 Participants |
| Lonafarnib/Ritonavir - VI | ALT Normalization at End of Treatment | 2 Participants |
| Lonafarnib/Ritonavir - VII | ALT Normalization at End of Treatment | 6 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - VIII | ALT Normalization at End of Treatment | 0 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - IX | ALT Normalization at End of Treatment | 5 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - X | ALT Normalization at End of Treatment | 2 Participants |
Secondary
< LLOQ in HDV RNA at End of Treatment (EOT)
Proportion of intent to treat patients with HDV RNA below the limit of quantitation at end of treatment
Time frame: 12-48 weeks
Population: intent to treat population
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Lonafarnib/Ritonavir - I | < LLOQ in HDV RNA at End of Treatment (EOT) | 0 Participants |
| Lonafarnib/Ritonavir - II | < LLOQ in HDV RNA at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - III | < LLOQ in HDV RNA at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - IV | < LLOQ in HDV RNA at End of Treatment (EOT) | 0 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - V | < LLOQ in HDV RNA at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir - VI | < LLOQ in HDV RNA at End of Treatment (EOT) | 0 Participants |
| Lonafarnib/Ritonavir - VII | < LLOQ in HDV RNA at End of Treatment (EOT) | 6 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - VIII | < LLOQ in HDV RNA at End of Treatment (EOT) | 1 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - IX | < LLOQ in HDV RNA at End of Treatment (EOT) | 3 Participants |
| Lonafarnib/Ritonavir/PEG IFN-a - X | < LLOQ in HDV RNA at End of Treatment (EOT) | 2 Participants |
Other Pre-specified
Mean HDV RNA Decline
mean HDV RNA decline of intent to treat population from baseline to end of treatment
Time frame: 12-48 weeks
Population: intent to treat population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lonafarnib/Ritonavir - I | Mean HDV RNA Decline | -1.39 log HDV RNA IU/mL | Standard Error 1.27 |
| Lonafarnib/Ritonavir - II | Mean HDV RNA Decline | 0.33 log HDV RNA IU/mL | Standard Error 1.08 |
| Lonafarnib/Ritonavir - III | Mean HDV RNA Decline | -1.11 log HDV RNA IU/mL | Standard Error 3.1 |
| Lonafarnib/Ritonavir - IV | Mean HDV RNA Decline | -0.67 log HDV RNA IU/mL | Standard Error 0.24 |
| Lonafarnib/Ritonavir/PEG IFN-a - V | Mean HDV RNA Decline | -1.97 log HDV RNA IU/mL | Standard Error 1.6 |
| Lonafarnib/Ritonavir - VI | Mean HDV RNA Decline | -0.31 log HDV RNA IU/mL | Standard Error 1.61 |
| Lonafarnib/Ritonavir - VII | Mean HDV RNA Decline | -1.94 log HDV RNA IU/mL | Standard Error 1.3 |
| Lonafarnib/Ritonavir/PEG IFN-a - VIII | Mean HDV RNA Decline | -2.85 log HDV RNA IU/mL | Standard Error 0.49 |
| Lonafarnib/Ritonavir/PEG IFN-a - IX | Mean HDV RNA Decline | -2.69 log HDV RNA IU/mL | Standard Error 1.66 |
| Lonafarnib/Ritonavir/PEG IFN-a - X | Mean HDV RNA Decline | -3.81 log HDV RNA IU/mL | Standard Error 0.94 |