Lonafarnib With Ritonavir in HDV (LOWR-2)
Lonafarnib With Ritonavir in HDV (LOWR-2)
An Open-label, Dose-ranging Study to Evaluate the Safety and Efficacy of Lonafarnib With
 Ritonavir Boosting in Patients Chronically Infected With Delta Hepatitis (HDV) (LOWR-2).
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 forty-five subjects with chronic
 delta hepatitis will be randomized to receive one of nine 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 PEG
 IFN-alpha.
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/mm3; platelet count <
 100,000 cells/mm3; 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/m2

 -  Concomitant drugs known to prolong the QT interval