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

Phase 2

Completed

Conditions: Chronic Hepatitis D Infection

Interventions: Drug: lonafarnib
Drug: ritonavir
Drug: Pegylated interferon-alfa-2a

Registration Number: NCT02430194

Lead Sponsor: Eiger BioPharmaceuticals

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).

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 55

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

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
lonafarnib/ritonavir/PEG IFN-a - X	Pegylated interferon-alfa-2a	lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib/ritonavir/PEG IFN-a - IX	Pegylated interferon-alfa-2a	lonafarnib 25 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib/ritonavir/PEG IFN-a - V	Pegylated interferon-alfa-2a	lonafarnib 75 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir/PEG IFN-a - VIII	Pegylated interferon-alfa-2a	lonafarnib 50 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir - VII	ritonavir	lonafarnib 50 mg BID + ritonavir 100 mg BID
lonafarnib/ritonavir - III	ritonavir	lonafarnib 100 mg QD + ritonavir 100 mg QD
lonafarnib/ritonavir - VII	lonafarnib	lonafarnib 50 mg BID + ritonavir 100 mg BID
lonafarnib/ritonavir - I	ritonavir	lonafarnib 100 mg BID + ritonavir 100 mg QD
lonafarnib/ritonavir - IV	ritonavir	lonafarnib 150 mg QD + ritonavir 100 mg QD
lonafarnib/ritonavir - II	ritonavir	lonafarnib 100 mg BID + ritonavir 50 mg BID
lonafarnib/ritonavir - IV	lonafarnib	lonafarnib 150 mg QD + ritonavir 100 mg QD
lonafarnib/ritonavir/PEG IFN-a - V	ritonavir	lonafarnib 75 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir - VI	ritonavir	lonafarnib 25 mg BID + ritonavir 100 mg BID
lonafarnib/ritonavir - VI	lonafarnib	lonafarnib 25 mg BID + ritonavir 100 mg BID
lonafarnib/ritonavir/PEG IFN-a - VIII	ritonavir	lonafarnib 50 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir/PEG IFN-a - IX	ritonavir	lonafarnib 25 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib/ritonavir/PEG IFN-a - X	lonafarnib	lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib/ritonavir/PEG IFN-a - X	ritonavir	lonafarnib 50 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW
lonafarnib/ritonavir - I	lonafarnib	lonafarnib 100 mg BID + ritonavir 100 mg QD
lonafarnib/ritonavir - II	lonafarnib	lonafarnib 100 mg BID + ritonavir 50 mg BID
lonafarnib/ritonavir - III	lonafarnib	lonafarnib 100 mg QD + ritonavir 100 mg QD
lonafarnib/ritonavir/PEG IFN-a - V	lonafarnib	lonafarnib 75 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir/PEG IFN-a - VIII	lonafarnib	lonafarnib 50 mg BID + ritonavir 100 mg BID (+ PEG IFN-a 180 ug QW on Week 12)
lonafarnib/ritonavir/PEG IFN-a - IX	lonafarnib	lonafarnib 25 mg BID + ritonavir 100 mg BID + PEG IFN-a 180 ug QW

Primary Outcome Measures

Name	Time	Method
≥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 Outcome Measures

Name	Time	Method
ALT Normalization at End of Treatment	12-48 weeks	Proportion of intent to treat population who normalize ALT at end of treatment
< 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