JAK1/2 inhibition with baricitinib in the treatment of autoinflammatory interferonopathies.

Abstract

BACKGROUND:

Monogenic IFN-mediated autoinflammatory diseases present in infancy with systemic inflammation, an IFN response gene signature, inflammatory organ damage, and high mortality. We used the JAK inhibitor baricitinib, with IFN-blocking activity in vitro, to ameliorate disease.

METHODS:

Between October 2011 and February 2017, 10 patients with CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperatures), 4 patients with SAVI (stimulator of IFN genes-associated [STING-associated] vasculopathy with onset in infancy), and 4 patients with other interferonopathies were enrolled in an expanded access program. The patients underwent dose escalation, and the benefit was assessed by reductions in daily disease symptoms and corticosteroid requirement. Quality of life, organ inflammation, changes in IFN-induced biomarkers, and safety were longitudinally assessed.

RESULTS:

Eighteen patients were treated for a mean duration of 3.0 years (1.5-4.9 years). The median daily symptom score decreased from 1.3 (interquartile range [IQR], 0.93-1.78) to 0.25 (IQR, 0.1-0.63) (P < 0.0001). In 14 patients receiving corticosteroids at baseline, daily prednisone doses decreased from 0.44 mg/kg/day (IQR, 0.31-1.09) to 0.11 mg/kg/day (IQR, 0.02-0.24) (P < 0.01), and 5 of 10 patients with CANDLE achieved lasting clinical remission. The patients' quality of life and height and bone mineral density Z-scores significantly improved, and their IFN biomarkers decreased. Three patients, two of whom had genetically undefined conditions, discontinued treatment because of lack of efficacy, and one CANDLE patient discontinued treatment because of BK viremia and azotemia. The most common adverse events were upper respiratory infections, gastroenteritis, and BK viruria and viremia.

CONCLUSION:

Upon baricitinib treatment, clinical manifestations and inflammatory and IFN biomarkers improved in patients with the monogenic interferonopathies CANDLE, SAVI, and other interferonopathies. Monitoring safety and efficacy is important in benefit-risk assessment.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01724580 and NCT02974595.

FUNDING:

This research was supported by the Intramural Research Program of the NIH, NIAID, and NIAMS. Baricitinib was provided by Eli Lilly and Company, which is the sponsor of the expanded access program for this drug.

• Authors: Gina A Montealegre Sanchez, Adam Reinhardt, Suzanne Ramsey, Helmut Wittkowski, Philip J Hashkes, Yackov Berkun, Susanne Schalm, Sara Murias, Jason A Dare, Diane Brown, Deborah L Stone, Ling Gao, Thomas Klausmeier, Dirk Foell, Adriana A de Jesus, Dawn C Chapelle, Hanna Kim, Samantha Dill, Robert A Colbert, Laura Failla, Bahar Kost, Michelle O'Brien, James C Reynolds, Les R Folio, Katherine R Calvo, Scott M Paul, Nargues Weir, Alessandra Brofferio, Ariane Soldatos, Angelique Biancotto, Edward W Cowen, John J Digiovanna, Massimo Gadina, Andrew J Lipton, Colleen Hadigan, Steven M Holland, Joseph Fontana, Ahmad S Alawad, Rebecca J Brown, Kristina I Rother, Theo Heller, Kristina M Brooks, Parag Kumar, Stephen R Brooks, Meryl Waldman, Harsharan K Singh, Volker Nickeleit, Maria Silk, Apurva Prakash, Jonathan M Janes, Seza Ozen, Paul G Wakim, Paul A Brogan, William L Macias, Raphaela Goldbach-Mansky
• Journal: The Journal of clinical investigation (J Clin Invest) Vol. 128 Issue 7 Pg. 3041-3052 (07 02 2018) ISSN: 1558-8238 [Electronic] United States
• PMID: 29649002 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)

Chemical References

• Azetidines
• Janus Kinase Inhibitors
• Purines
• Pyrazoles
• Sulfonamides
• Interferons
• JAK1 protein, human
• JAK2 protein, human
• Janus Kinase 1
• Janus Kinase 2
• baricitinib

Topics

• Adolescent
• Azetidines (administration & dosage, adverse effects, therapeutic use)
• Child
• Child, Preschool
• Cohort Studies
• Compassionate Use Trials
• Female
• Hereditary Autoinflammatory Diseases (drug therapy, enzymology, immunology)
• Humans
• Infant
• Inflammation (drug therapy, enzymology, immunology)
• Interferons (antagonists & inhibitors, metabolism)
• Janus Kinase 1 (antagonists & inhibitors)
• Janus Kinase 2 (antagonists & inhibitors)
• Janus Kinase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Male
• Prospective Studies
• Purines
• Pyrazoles
• Sulfonamides (administration & dosage, adverse effects, therapeutic use)
• Treatment Outcome
• Young Adult