Lonafarnib Boosted With Ritonavir With and Without Peginterferon Alfa-2a (PEG IFN-a) in HDV (LOWR-2)

NCT ID: NCT02430194

Last Updated: 2023-03-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 55 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-12-31
• Study Completion Date: 2017-06-15

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).

Conditions

Chronic Hepatitis D Infection

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

lonafarnib/ritonavir - I

lonafarnib 100 mg BID + ritonavir 100 mg QD

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir - II

lonafarnib 100 mg BID + ritonavir 50 mg BID

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir - III

lonafarnib 100 mg QD + ritonavir 100 mg QD

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir - IV

lonafarnib 150 mg QD + ritonavir 100 mg QD

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir/PEG IFN-a - V

lonafarnib 75 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

Pegylated interferon-alfa-2a

Intervention Type: DRUG

immunomodulator

lonafarnib/ritonavir - VI

lonafarnib 25 mg BID + ritonavir 100 mg BID

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir - VII

lonafarnib 50 mg BID + ritonavir 100 mg BID

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

lonafarnib/ritonavir/PEG IFN-a - VIII

lonafarnib 50 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

Pegylated interferon-alfa-2a

Intervention Type: DRUG

immunomodulator

lonafarnib/ritonavir/PEG IFN-a - IX

lonafarnib 25 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

Pegylated interferon-alfa-2a

Intervention Type: DRUG

immunomodulator

lonafarnib/ritonavir/PEG IFN-a - X

lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW

Group Type: EXPERIMENTAL

lonafarnib

Intervention Type: DRUG

antiviral farnesyl transferase inhibitor

ritonavir

Intervention Type: DRUG

CYP 3A4 inhibitor, lonafarnib booster

Pegylated interferon-alfa-2a

Intervention Type: DRUG

immunomodulator

Interventions

lonafarnib

antiviral farnesyl transferase inhibitor

Intervention Type: DRUG

ritonavir

CYP 3A4 inhibitor, lonafarnib booster

Intervention Type: DRUG

Pegylated interferon-alfa-2a

immunomodulator

Intervention Type: DRUG

Other Intervention Names

Sarasar, EBP994, LNF; Norvir, RTV; Pegasys; PEG IFN-alfa-2a; Peginterferon alfa-2a; PEG IFN-a

Eligibility Criteria

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

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ankara University

OTHER

Sponsor Role: collaborator

Eiger BioPharmaceuticals

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Cihan Yurdaydin, MD

Role: PRINCIPAL_INVESTIGATOR

Ankara University

Locations

Ankara University Medical School

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

Yurdaydin C, Keskin O, Yurdcu E, Caliskan A, Onem S, Karakaya F, Kalkan C, Karatayli E, Karatayli S, Choong I, Apelian D, Koh C, Heller T, Idilman R, Bozdayi AM, Glenn JS. A phase 2 dose-finding study of lonafarnib and ritonavir with or without interferon alpha for chronic delta hepatitis. Hepatology. 2022 Jun;75(6):1551-1565. doi: 10.1002/hep.32259. Epub 2021 Dec 23.

Reference Type: DERIVED

PMID: 34860418 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

http://eigerbio.com

Eiger BioPharmaceuticals company website

Other Identifiers

EIG-300-Amendment 3

Identifier Type: -

Identifier Source: org_study_id