Mathematical Modeling of HDV RNA, HBV DNA, and HBsAg Dynamics During Lonafarnib-Based Therapy: Insights from the LOWR HDV-1 Study.

Authors

Adquate Mhlanga, Louis Shekhtman, Rami Zakh, Sarah Duehren, Ashish Goyal, Alexander Churkin, Vladimir Reinharz, Danny Barash, Jeffrey Glenn, Ohad Etzion, Scott J Cotler, Cihan Yurdaydin, Harel Dahari

Published in

Bulletin of mathematical biology. Volume 88. Issue 9. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

Lonafarnib (LNF) is an investigational drug targeting hepatitis delta virus (HDV) but not hepatitis B virus (HBV), providing a unique opportunity to model HDV kinetics and how changes in HDV affect HBV. We performed a detailed kinetic analysis and developed a mathematical model to explain serum HBV DNA, HDV RNA and hepatitis B surface antigen (HBsAg) kinetics in 15 HBV/HDV coinfected patients receiving LNF-based treatment. After a delay of 0-2 days, patients experienced a rapid 1st-phase HDV-decline followed by either a viral plateau, 2nd slower-decline phase, or viral breakthrough (VB). LNF monotherapy led to a flat-partial-response (often followed by VB), while LNF combination therapy with ritonavir or pegylated interferon-α (PEG-IFN $\alpha$ ) was associated with a biphasic HDV decline (without VB). All treatments except LNF + PEG-IFN $\alpha$ had at least one patient experiencing an increase in HBV on-treatment. Our model successfully reproduced the observed HDV and HBV kinetics. We estimated an HDV RNA half-life of 1.26 days [95% confidence interval, CI 1.05-1.47] in serum and treatment efficacy of 94% in inhibiting HDV RNA production across all treatments [95% CI 89-97%], as reflected by the 1st phase HDV decline. The 2nd phase of HDV decline was explained by a time-dependent increase in efficacy, reaching a maximum of 98.9%. The model explained the increase in serum HBV DNA by a median four-fold [interquartile range, IQR: 1-28] increase in HBV DNA production rate when HDV declined below an inhibitory threshold. The stability of serum HBsAg was explained by a constant number of HBsAg-producing cells.

PMID:
42560568
Bibliographic data and abstract were imported from PubMed on 06 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.