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**Lonafarnib + peginterferon alfa-2a** is an investigational combination therapy for chronic hepatitis D virus (HDV) infection. **Lonafarnib** is a first-in-class oral farnesyltransferase inhibitor that blocks the prenylation of the large delta antigen of HDV, a step required for viral replication and assembly. **Peginterferon alfa-2a** is a pegylated form of recombinant human interferon alfa used to stimulate the innate antiviral response via activation of type 1 interferon receptors, leading to downstream activation of the JAK/STAT pathway and induction of antiviral gene transcription. The combination, often administered with ritonavir as a pharmacokinetic booster, has shown enhanced antiviral efficacy compared to monotherapy in phase 2 studies for chronic HDV, resulting in greater reductions in HDV RNA and improvement in biochemical markers.
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