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Hepatitis D, ChronicPhase 3LOWR6NCT05229991

Once Daily Dosing of Lonafarnib Co-administered With Ritonavir for Treatment of Chronic Hepatitis D Virus Infection

A Phase 3 study testing Lonafarnib and Ritonavir in people with Hepatitis D, Chronic, run by Soroka University Medical Center at 3 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Open label, single arm, multi-center clinical trial of lonafarnib 50 mg QD plus ritonavir 200 mg QD, administered orally, over a 48-week treatment period, with a 24-week post-treatment follow-up period, in patients with chronic Hepatitis D Virusinfection. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hepatitis D, Chronic
What is being tested?
Lonafarnib and Ritonavir
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
3 sitesin 3 countries
Study dates
15 May 2021to 5 Feb 2025
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Chronic HDV infection, with compensated liver disease, documented by a positive HDV antibody (Ab) test and HDV RNA by quantitative polymerase chain reaction (qPCR) assay, prior to initiation of trial treatment.
  • Demonstrable suppression of HBV DNA (< 100 IU/mL) following anti-HBV nucleos(t)ide treatment prior to initiating trial therapy.
  • Willing and able to comply with trial procedures and provide written informed consent.
  • ALT > ULN documented on at least one occasion during the 12 months preceding enrollment to the trial.
  • Male and female participants who are 18 years of age or above.
  • ECGs demonstrating no acute ischemia or clinically significant (CS) abnormality and a corrected QT interval by Fridericia correction formula (QTcF) < 450 ms in males and <470 ms in females.
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  • Sexually active female patients of childbearing potential and sexually active male patients with partners of childbearing potential must agree to use adequate methods of contraception during the trial. Females of childbearing potential are all those except women who are surgically sterile, who have medically documented ovarian failure, or who are at least 1 year postmenopausal.
  • For female patients:
  • Progestin-based hormonal contraception (implant, injection, oral) associated with inhibition of ovulation for ≥ 3 months before screening. Use of a progestin-based implant or injection method requires the additional use of a barrier method (use of condom [male partner] or diaphragm with spermicide or cervical cap with spermicide) from screening. Use of a progestin-only, oral method requires the additional use of double barrier methods (use of condom [male partner] with either diaphragm with spermicide or cervical cap with spermicide) from screening, or
  • Intrauterine device (IUD) or intrauterine system (IUS) in place ≥ 3 months before screening AND a barrier method (use of condom [male partner] or diaphragm with spermicide or cervical cap with spermicide) from screening, or
  • Surgical sterilization of the partner (vasectomy ≥ 1 month before screening) AND a barrier method (use of condom [male partner] or diaphragm with spermicide or cervical cap with spermicide) from screening, or
  • Double-barrier methods (use of condom [male partner] with either diaphragm with spermicide or cervical cap with spermicide) from screening.
  • For male patients:
  • Surgical sterilization (vasectomy ≥ 1 month before screening) AND a barrier method (use of condom or diaphragm with spermicide or cervical cap with spermicide) from screening, or
  • Consistently and correctly use a condom from screening AND female partner must agree to use a hormonal contraceptive, a nonhormonal non-barrier method (eg, copper IUD), or a nonhormonal barrier method (eg, diaphragm with spermicide or cervical cap with spermicide).

Who cannot join

  • Participation in a clinical trial with, or use of, any investigational agent within 30 days or 5 half-lives, whichever is longer, before starting LNF treatment.
  • Female patients who are pregnant or breastfeeding. Female patients must have a negative serum test at screening and a negative urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [hCG] at baseline, within 24 hours prior to the start of any investigational agent). Male patients with female sexual partners who are pregnant.
  • Current or previous history of decompensated liver disease (e.g. variceal bleeding, ascites, hepatic encephalopathy, hepatorenal syndrome).
  • Platelet count < 70,000 cells/mm3; white blood cell (WBC) < 3,000 cells / mm3
  • Creatinine clearance (< 30 mL/min by Cockroft-Gault).
  • Co-infected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV). Patients with a positive HCV Ab at baseline are allowed if they have completed a curative antiviral regimen and have documented undetectable HCV RNA 12 weeks or more following last dose of anti-HCV medications.
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  • Abnormal thyroid-stimulating hormone (TSH) or free thyroxine (fT4) levels. Patients with well-controlled thyroid function or TFTs that are not clinically significant may be enrolled.
  • Evidence of another form of viral hepatitis or another form of liver disease (eg, autoimmune liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson's disease, alcoholic liver disease, nonalcoholic steatohepatitis, hemochromatosis, alpha 1 anti-trypsin deficiency).
  • History of hepatocellular carcinoma.
  • Retinal disorder or clinically relevant ophthalmic disorder
  • Any malignancy within 5 preceding years. Exceptions are malignancies surgically excised with curative intent and/or evidence of being disease free for at least 5 years (eg, breast ductal carcinoma in situ [DCIS] or squamous/basal cell skin cancer treated with curative intent), or successfully treated in-situ carcinoma of the cervix
  • Other significant medical condition that may require intervention during the trial.
  • Any condition that may impact proper absorption (eg, short bowel syndrome, inflammatory bowel disease, atrophic gastritis, partial gastrectomy) should be discussed with the Medical Monitor.
  • Consumption of grapefruit, Seville oranges, or product that contains grapefruit or Seville oranges.
  • Use of heparin or warfarin during the trial.
  • Long-term treatment (> 2 weeks) before or during the trial with agents that have a high risk for nephrotoxicity or hepatotoxicity.
  • Concomitant use (within 2 weeks of Day 1 and throughout trial conduct) of any medications (prescription, OTC, herbal products) or foods as follows:
  • Known potent inhibitors of CYP3A, including statins (with the exception of pravastatin and fluvastatin);
  • Known potent inducers of CYP3A or CYP3A sensitive substrates;
  • Known CYP2C19 and P-gp sensitive substrates with a narrow therapeutic index - refer to the Concomitant Medication Manual for additional instructions;
  • Known sensitive substrates of OCT1 with a narrow therapeutic index; and
  • Drugs known to prolong the PR or QT interval unless otherwise described in this protocol.
  • Concomitant use of medications contraindicated in the prescribing information for RTV.

Trial locations and contacts

3 sites in 3 countries.

3 sites in 3 countries

Israel1 site
  • Soroka UMC

    Beersheba

Other trials in Israel

New Zealand1 site
  • New Zealand Liver Transplant Unit, Auckland City Hospital

    Auckland

Other trials in New Zealand

Turkey (Türkiye)1 site
  • Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey

    Istanbul

Other trials in Turkey (Türkiye)

About this study

Official title: Once Daily (QD) Dosing of Lonafarnib (LNF) Co-administered With Ritonavir (RTV) for Treatment of Chronic Hepatitis D Virus Infection

Open label, single arm, multi-center clinical trial of lonafarnib 50 mg QD plus ritonavir 200 mg QD, administered orally, over a 48-week treatment period, with a 24-week post-treatment follow-up period, in patients with chronic Hepatitis D Virusinfection.

Objectives: To evaluate the safety and tolerability of once daily dosing of lonafarnib 50 mg with ritonavir 200 mg over a 48-week treatment period.

To evaluate the effect of once daily dosing of lonafarnib 50 mg with ritonavir 200 mg over a 48-week treatment period with a 24-week post-treatment follow-up on HDV viral levels.

Trial population: Up to 30 patients with chronic HDV infection with detectable HDV RNA and compensated liver disease.

Read the detailed description

Background: Hepatitis D virus (HDV) was identified as the infectious agent causing viral hepatitis in the presence of hepatitis B virus (HBV). While HDV can replicate autonomously inside the hepatocyte, the virus requires co-infection with HBV to complete virion assembly and to facilitate transmission. HDV causes the most severe form of viral hepatitis, with rapid progression to cirrhosis and high rates of development of hepatocellular carcinoma. Currently there are no FDA approved therapies for chronic HDV infection (CHD) which presents an unmet medical need. The off-label use of pegylated interferon alpha (Alpha) for the treatment of CHD has so far been explored in several small single-arm studies and in 2 randomized controlled clinical trials, showing limited efficacy and high relapse rates. In addition, Alpha is associated with a poor tolerability profile and its use is limited in patients with advanced disease.

Lonafarnib (LNF), a FT inhibitor has been evaluated in over 2,000 subjects in clinical studies, comprising more than fifty Phase 1 and Phase 2 studies and two Phase 3 studies, with healthy subjects and patients with HDV, cancer, Hutchinson-Gilford progeria syndrome (HGPS) and progeroid laminopathies. Treatment with LNF has been administered as continuous (up to 11 years in HGPS) and intermittent therapy (exceeding one year in cancer patients).

The use of LNF in CHD has been assessed in a proof of concept study, a series of four phase 2 clinical trials (the LOWR program) and an on-going phase 3 clinical trial (D-LIVR study).

Hypothesis: that treatment with LNF50/RTV200 QD for 48 weeks will be safe and lead to a reduction in HDV RNA levels at end of treatment and end of follow up.

Procedures: At baseline, systems review, physical examination, vital signs (temperature, blood pressure, pulse rate per minute), anthropometric measurements (weight, height and BMI) and ECG will be performed. Information regarding the use of alcohol and drugs, symptoms and use of concomitant medications collected. Blood will be drawn for testing of local CBC, chemistry, coagulation studies, HDV antibody and RNA levels, HCV antibody (\& RNA if necessary), HBsAg levels, HBeAg status, HBV DNA levels, liver elastography and ultrasound. All blood tests besides HDV RNA levels, will be performed at a local lab. HDV RNA level testing will be performed at a central laboratory. Pregnancy test will be performed in females of child-bearing potential. Trial medications will be dispensed. Use of anti-HBV therapy (tenofovir or entecavir) will be confirmed.

Follow up visits will be conducted at week 4, 12, 24, 36 and 48 of treatment and at 24 weeks after stopping treatment and will include systems review, ECG recordings, evaluation of concomitant medications use, adverse events monitoring and assessment of compliance with trial medications and anti HBV therapy. In addition, blood will be drawn for measurement of CBC, chemistry panel, coagulation tests and HDV RNA and HBV DNA levels at each visit. Trial medications will be dispensed at each visit during the treatment phase of trial.

Adverse events and concomitant medications will be collected throughout the trial.

Data to capture:

  • Demographic data: Gender, age, ethnicity, country of birth
  • Detailed medical history: including currently prescribed medications, recently administered medications, dispensing date, past medications use and dispensing date, past medical diagnosis including diagnosis date, past medical procedures including procedure date, allergies.
  • Habits: history of recreational drugs and alcohol consumption (using CAGE questionnaire).
  • Clinical evaluation: Systems review, anthropometric measurements (weight, height and BMI), physical examination, vital signs, symptom questionnaire and AE assessment.
  • Blood tests: Complete blood count, biochemistry panel, coagulation tests, anti-HDV antibody, anti HCV antibody, HDV RNA, HBV DNA.

Safety data collected during the trial (e.g., AEs and laboratory test results) will be monitored on an ongoing basis by the trial team.

Being tested
Lonafarnib, Ritonavir
Keywords
Hepatitis D, Lonafarnib, Ritonavir, Hepatitis B
Medical subject headings
Hepatitis D, Chronic, Hepatitis D, Hepatitis B

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LonafarnibDrug

    Also called LNF

    once-daily dosing of lonafarnib 50 mg with ritonavir 200 mg over a 48-week treatment period.

  • RitonavirDrug

    Also called Norvir

    once-daily dosing of lonafarnib 50 mg with ritonavir 200 mg over a 48-week treatment period.

Study groups in NCT05229991
Study groupRoleWhat they receive
Intervention GroupExperimentalLonafarnib 50mg co-administered with ritonavir 200 mg
Receives: Drug: Lonafarnib; Drug: Ritonavir

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Viral load change

    Change from baseline in HDV viral load at end of treatment

    Measured: 48 weeks

  2. Viral load change

    Change from baseline in HDV viral load at end of follow-up

    Measured: 72 weeks

Secondary outcomes (2)
  1. HDV RNA levels below LLOQ

    Proportion of patients with HDV RNA levels below limit of quantification (LLOQ) at end of treatment and end of follow up

    Measured: 72 weeks

  2. Viral load change

    Change from baseline in HDV viral load at weeks 4, 12 and 24

    Measured: 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Feb 2022
  2. Study start15 May 2021
  3. Primary completion5 Feb 2025
  4. Study completion5 Feb 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
LNF50/RTV200 QD will be administered orally, over a 48-week treatment period, with a 24-week post-treatment follow-up period, in patients with chronic HDV infection.
Masking
None (open label)
Enrolment
10 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05229991
Sponsor's protocol ID
SOR-0527-20-CTIL
Other IDs
SCRC20042
Acronym
LOWR6
Status last verified
Apr 2026
First submitted
27 Jan 2022
Last updated
30 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Lonafarnib and Ritonavir in people with Hepatitis D, Chronic, run by Soroka University Medical Center at 3 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Israel, New Zealand, Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Viral load change (time frame: 48 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Apr 2026.

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