Study of Baricitinib, a JAK1/2 Inhibitor, in Chronic Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

• ClinicalTrials.gov Identifier: NCT02759731
• Recruitment Status: Recruiting
• First Posted: May 3, 2016
• Last Update Posted: September 18, 2019
• Sponsor: National Cancer Institute (NCI)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Study Description

Brief Summary:

Background:

Chronic graft versus host disease (cGVHD) can affect people who had a hematopoietic stem cell transplant using donor cells. It is often fatal. It is usually treated with high doses of steroids. But that helps only about half the people in the long term. Researchers want to see if a drug called baricitinib can help people with cGVHD that has not responded to therapy. The drug inhibits the proteins involved in communication in the immune system. These proteins may play a role in cGVHD and other inflammatory diseases.

Objectives:

To test the safety and effectiveness of baricitinib in people with cGVHD that has not responded to therapy.

Eligibility:

Adults 18 and older with cGVHD that has not responded to therapy.

Design:

Participants will be screened with a medical history, physical exam, and blood and urine tests. They will have lung and heart tests and chest scans.

Baseline visit: Participants will have:

Medical history

Physical exam

Blood tests

Tests for infectious diseases

Skin, eye, and teeth evaluations

Rehabilitation and occupational medicine evaluations

Photos of any lesions

Gynecology evaluation (females)

The study will occur in 28-day cycles. Participants will take the study drug by mouth every day for 3 cycles. Some will take it for 3 or 6 more cycles.

Participants will have a few visits during each cycle. They will repeat some previous tests. They may also have scans and questionnaires.

Participants will have a visit when they stop taking the drug and another 3 months later. They will repeat a few study tests. They will have follow-up calls for 2 years.

Condition or disease	Intervention/treatment	Phase
Chronic Graft vs Host Disease; Chronic Graft-Versus-Host Disease	Drug: Baricitinib	Phase 1; Phase 2

  Show Detailed Description

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 31 participants
• Allocation: Non-Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 1/2 Study of Baricitinib, a JAK1/2 Inhibitor, in Chronic Graft-Versus-Host Disease (cGVHD) After Allogeneic Hematopoietic Stem Cell Transplantation (SCT)
• Actual Study Start Date: November 1, 2016
• Estimated Primary Completion Date: January 1, 2020
• Estimated Study Completion Date: June 1, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: Arm 1; Baricitinib starting at a dose of 2mg daily for 12 weeks. If the response at 12 weeks is a CR and there has not been a DLT, the dose will be remain at 2mg daily for an additional 12 weeks. If there has been a DLT within the first 4 weeks, the dose will be decreased to 1mg daily, and will continue at this dose as tolerated. If there has been DLT at this dose (1 mg), patients will be taken off treatment.	Drug: Baricitinib; Cycle=28 days: Baricitinib: 1mg-4mg PO QD
Experimental: Arm 2; If the response is a PR or stable disease (from cohort 1), the dose will be increased to 4mg daily for an additional 12 weeks. If there has been a DLT within the first 4 weeks will have a dose reduction back to 2mg daily. For patients who experience cGVHD progression at any time within the first 12 weeks on 2mg daily, the dose can be increased to 4mg daily until 24 weeks.	Drug: Baricitinib; Cycle=28 days: Baricitinib: 1mg-4mg PO QD

Outcome Measures

Primary Outcome Measures :

1. To evaluate the safety of baricitinib [ Time Frame: every 2 weeks during the first 4 weeks of each dose level then every 4 weeks. ]
   Safety
2. To evaluate the efficacy of baricitinib [ Time Frame: 24 weeks ]
   Efficacy

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 99 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

-INCLUSION CRITERIA:

1. Moderate or severe cGVHD (after allogeneic hematopoietic stem cell transplantation) diagnosed and staged per NIH criteria. Responses to JAK inhibitors have not been restricted to specific organs, so any organ involvement is eligible.
2. Age greater than or equal to 18 years of age. Because inadequate dosing or adverse event data are currently available on the use of baricitinib in patients <18 years of age, children are excluded from this study.
3. Karnofsky performance score >50%
4. Chronic GVHD that did not respond to high-dose corticosteroids (prednisone at 1.0 mg/kg/day for at least 1 week or prednisone at 0.5 mg/kg/day or 1 mg/kg every other day for at least 4 weeks), or second-line therapy (any).
5. If patient is taking systemic therapy for cGVHD at the time of enrollment, they must be on a stable or tapering doses in the preceding 4 weeks.

6. Patients must have normal organ and marrow function as defined below:

   absolute neutrophil count greater than or equal to 1,000/mcL

   absolute lymphocyte count greater than or equal to 500/mcL

   platelets greater than or equal to 50,000/mcL

   hemoglobin greater than or equal to 9 g/dL

   total bilirubin less than or equal to 1.5 X institutional upper limit of normal, unless there is a known history of Gilbert s disease

   AST(SGOT)/ALT(SGPT) less than or equal to 3 X institutional upper limit of normal

   • Creatinine < 1.5 times the upper limit of normal, or:

   creatinine clearance greater than or equal to 50 mL/min/1.73 m^2. Creatinine clearance should be calculated per institutional standard.

7. Primary malignancy for which the patient received transplant has been stable for 3 months prior to enrollment on study.
8. The effects of baricitinib on human fetal development are unknown. Women of child-bearing potential and men must agree to use 2 effective forms of contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation and for at least 7 days after study drug exposure. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, or if a man s partner becomes pregnant or suspects she is pregnant while he is participating in this study, she or he should inform their treating physician immediately.
9. Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

1. Systemic immune suppression or systemic therapy for cGVHD started within preceding 4 weeks.
2. Hypersensitivity to JAK inhibitors.
3. Any serious medical condition within the previous 4 weeks which places the subject at an unacceptable risk if he or she were to participate in the study or confounds the ability to interpret data from the study, including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmias, acute kidney injury, or psychiatric illness/social situations that would limit compliance with study requirements.
4. Uncontrolled infection, including active HIV-1, Hepatitis B (HBV) and/or Hepatitis C (HCV) infection (positive HBV or HCV viral load in the setting of positive HBV core antibody or surface antibody or HCV antibody). History of HBV or HCV is allowed if there is no uncontrolled viral infection. Because the study agent may impact response to infections, patients with any active viral infection are excluded.
5. Recurrent or progressive malignancy requiring anticancer treatment.
6. Other cancer except that for which the transplant was done <2 years before study entry, except non-melanoma skin cancer or carcinoma in situ of the uterine cervix or breast.
7. Patients who are receiving any other investigational agents.
8. NIH lung score 3.
9. Pregnant women are excluded from this study because the teratogenic effects of baricitinib are unknown. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with baricitinib, breastfeeding should be discontinued if the mother is treated with this agent.

Contacts and Locations

Contacts

Contact: Steven Z Pavletic, M.D.; (240) 760-6174; sp326h@nih.gov

Locations

United States, Maryland

National Institutes of Health Clinical Center; Recruiting

Bethesda, Maryland, United States, 20892

Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office 888-624-1937

Sponsors and Collaborators

National Cancer Institute (NCI)

Investigators

• Principal Investigator: Steven Z Pavletic, M.D.; National Cancer Institute (NCI)

More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

• Responsible Party: National Cancer Institute (NCI)
• ClinicalTrials.gov Identifier: NCT02759731 History of Changes
• Other Study ID Numbers: 160094; 16-C-0094
• First Posted: May 3, 2016
• Last Update Posted: September 18, 2019
• Last Verified: February 4, 2019

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):

Murine Models; Rheumatoid Arthritis; Corticosteroids; Systemic Therapy; Inflammatory Cytokines

Additional relevant MeSH terms:

Graft vs Host Disease; Immune System Diseases