The Role of Inflammation in Central Nervous System (CNS) Mechanisms of Anhedonia and Psychomotor Slowing in Depressed People With HIV
Overview
- Phase
- Phase 2
- Intervention
- Baricitinib
- Conditions
- HIV
- Sponsor
- Emory University
- Enrollment
- 60
- Locations
- 2
- Primary Endpoint
- Change in corticostriatal functional connectivity (FC) in reward circuit
- Status
- Recruiting
- Last Updated
- 11 months ago
Overview
Brief Summary
The purpose of this 10-week, double-blind, placebo-controlled study is to determine whether inflammation impacts reward and motor neural circuitry to contribute to depressive symptoms like anhedonia and psychomotor slowing in people with Human Immunodeficiency Virus (HIV) and depression. Sixty male and female patients with HIV who have depression, anhedonia and high inflammation and are stable on effective treatment for their HIV will be randomized to receive either the anti-inflammatory drug baricitinib or a placebo for 10 weeks. Participants will complete lab tests, medical and psychiatric assessments, neurocognitive testing, functional MRI (fMRI) scans, and optional spinal taps as part of the study.
Detailed Description
Risk of depression is substantially higher in people with HIV (PWH) than the general population, and depression in PWH confers worse outcomes regarding treatment adherence, morbidity, and mortality. Increased inflammation is one biological pathway that is linked to greater risk for depression in PWH and limits options for effective antidepressant therapy. Chronically elevated inflammation is associated with impairments within reward and motor neural circuits that contribute to symptoms of anhedonia (an inability to experience pleasure) and psychomotor slowing, which are overrepresented in PWH. The purpose of this 10-week, double-blind, placebo-controlled study is to provide mechanistic information on whether inflammation impacts corticostriatal reward and motor circuitry to contribute to anhedonia and psychomotor slowing in PWH with depression using the anti-inflammatory drug baricitinib. This study will utilize an FDA-approved medication, baricitinib, to establish whether the effects of inflammation on reward and motor circuits are a mechanism of anhedonia and motor slowing in PWH with depression, while advancing avenues for new therapies. Sixty male and female patients with HIV who have depression and high inflammation and are stable on effective treatment for their HIV will be randomized to receive either baricitinib or a placebo for 10 weeks. Participants will complete lab tests, medical and psychiatric assessments, neurocognitive testing, functional MRI (fMRI) scans, and optional spinal taps as part of the study.
Investigators
Andrew H Miller
Professor
Emory University
Eligibility Criteria
Inclusion Criteria
- •HIV infected on continuous antiretroviral therapy (ART) with plasma HIV RNA \<200 copies/ml for at least 12 months (on at least two previous clinic visits and confirmed at screening)
- •Current cluster of differentiation 4 (CD4+) \> 350 cells/microliter for at least twelve months (on at least two previous clinic visits and confirmed at screening)
- •A primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) major depression, current, or Bipolar, depressed type as diagnosed by the SCID-V
- •Score of ≥10 on the 9-item Patient Health Questionnaire (PHQ-9)
- •Off all antidepressant or other psychotropic therapy (e.g. mood stabilizers, antipsychotics, and sedative hypnotics) for at least 4 weeks (8 weeks for fluoxetine) or on a stable psychotropic regimen for at least 4 weeks prior to baseline visit
- •Significant anhedonia as reflected by a score ≥ 2 on item #1 of the PHQ-9
- •CRP≥2mg/L
- •Women of reproductive age will have a negative serum pregnancy test at study entry and both mend and women must agree to adequate contraception while
Exclusion Criteria
- •\< 18 years of age or \> 65 years of age
- •Pregnancy or breastfeeding
- •Significant hematological abnormalities at screening (ANC \< 1500, Hgb\<10, platelet\< 100,000)
- •History of progressive multifocal leukoencephalopathy
- •Untreated latent tuberculosis infection (which will be screened for prior to entry)
- •Having taken the following immunosuppressive medications within the past 6 months:
- •Oral corticosteroids
- •Biologic treatments such as etanercept, infliximab, certolizumab, adalimumab, golimumab, tocilizumab, abatacept, Ustekinumab, ixekizumab, secukinumab, or anakinra
- •Cyclophosphamide (or any other cytotoxic agent), belimumab, or anifrolumab (or another anti-interferon (IFN) therapy)
- •Rituximab, any other B cell depleting therapies, or intravenous immunoglobulin (IVIg)
Arms & Interventions
Baricitinib
Participants will be randomized to receive 10 weeks of treatment with baricitinib.
Intervention: Baricitinib
Placebo
Participants will be randomized to receive 10 weeks of treatment with placebo.
Intervention: Placebo
Outcomes
Primary Outcomes
Change in corticostriatal functional connectivity (FC) in reward circuit
Time Frame: Baseline visit, week 2, and week 10 after study medication
Patients will undergo resting-state and task-based functional magnetic resonance imaging (fMRI) to calculate functional connectivity (FC) between the ventral striatum (VS) and ventromedial prefrontal cortex (vmPFC). FC is measured as continuous Z scores reflecting the correlation of activity between the brain regions. Higher FC Z scores reflect stronger connectivity.
Secondary Outcomes
- Change in Effort Expenditure for Reward Task (EEfRT) Score(Baseline visit, week 2, and week 10)
- Change in Snaith-Hamilton Pleasure Scale-Self Report (SHAPS-SR) Score(Baseline visit, week 1, week 2, week 4, week 6, and week 10)
- Change in Motivation and Pleasure Scale-Self-Report (MAP-SR) Score(Baseline visit, week 1, week 2, week 4, week 6, and week 10)
- Change in Inventory of Depressive Symptoms Self Report (IDS-SR) Anhedonia Subscale Score(Baseline visit, week 1, week 2, week 4, week 6, and week 10)
- Change in Multidimensional Fatigue Inventory (MFI) Score(Baseline visit, week 1, week 2, week 4, week 6, and week 10)
- Change in Finger Tapping Task (FTT) Mean Number of Taps(Baseline visit, week 2, and week 10)
- Change in Finger Tapping Task (FTT) Total Number of Taps(Baseline visit, week 2, and week 10)
- Change in Trail Making Test Part A (TMT-A) Score(Baseline visit, week 2, and week 10)
- Change in Trail Making Test Part B (TMT-B) Score(Baseline visit, week 2, and week 10)
- Change in Digit Symbol Substitution Test (DSST) Score(Baseline visit, week 2, and week 10)