A Trial of Baricitinib in Patients With Cardiac Sarcoidosis

Phase 2

Not yet recruiting

• Conditions: Cardiac Sarcoidosis
• Interventions: Drug: Baricitinib (LY3009104) 4 mg

• Registration Number: NCT06868381
• Lead Sponsor: Stanford University

Brief Summary

The goal of this clinical trial is to learn if baricitinib in combination with a background steroid-sparing medication can treat active cardiac sarcoidosis in adults. The main question it aims to answer is:

- In patients with active cardiac sarcoidosis, does treatment with baricitinib improve cardiac sarcoidosis disease activity as assessed by changes on cardiac FDG-PET/CT?

Participants will:

* Take baricitinib in combination with a steroid-sparing therapy for up to 16 weeks

* Visit the clinic every two to four weeks for checkups and tests

* Be asked to complete questionnaires to see how they feel on baricitinib and medication diaries to record when they take baricitinib

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2025-03-03
• Study First Submitted QC: 2025-03-06
• Study First Posted: 2025-03-10
• Status Verified: 2025-04
• Last Update Submitted: 2025-04-29
• Last Update Posted: 2025-05-02
• Study Start: 2025-05-12
• Primary Completion: 2028-01-01
• Study Completion: 2028-04-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 10

Inclusion Criteria

• Diagnosis of cardiac sarcoidosis based on one of the following pathways:

  • Histological Diagnosis

    • Myocardial or extracardiac biopsy demonstrating non-caseating granuloma with no alternative cause identified AND
    • Abnormal FDG uptake on cardiac PET-CT conducted within six weeks of Screening, in a pattern consistent with active cardiac sarcoidosis AND
    • Exclusion of other causes for cardiac manifestations

  • Clinical Diagnosis

    • One or more of the following is present:

      • Steroid +/- immunosuppressant responsive cardiomyopathy or heart block
      • Unexplained reduced LVEF (< 40%) and/or segmental wall motion abnormalities not related to coronary artery disease or another defined cause
      • Unexplained sustained (spontaneous or induced) VT
      • Mobitz type II 2nd degree heart block or 3rd degree heart block
      • CT chest and/or FDG PET-CT showing features consistent with pulmonary sarcoidosis and/or hilar lymphadenopathy AND

    • Abnormal FDG uptake on cardiac PET-CT conducted within 6 weeks of Screening, in a pattern consistent with active cardiac sarcoidosis AND

    • Exclusion of other causes for cardiac manifestations

• Active cardiac sarcoidosis based on abnormal FDG uptake on cardiac PET-CT conducted within six weeks of Screening, in a pattern consistent with active cardiac sarcoidosis

• No current treatment with immunosuppressive medications other than a steroid-sparing medication (including methotrexate, leflunomide, azathioprine, or mycophenolate mofetil), and/or prednisone (or equivalent) at a dose of ≤ 20mg daily at Baseline

Key

Exclusion Criteria

• Receipt of a non-biologic DMARD or immunosuppressive agent other than methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine, or glucocorticoids within 28 days prior to screening

• Receipt of a bDMARD or tsDMARD, including non-depleting B-cell-directed therapy (eg, belimumab), T cell costimulatory blockade (eg, abatacept), TNF-alpha inhibition (eg, infliximab, adalimumab, etanercept, golimumab, certolizumab pegol), interleukin-6 inhibition (eg, tocilizumab, sarilumab), interleukin-1 inhibition (eg, anakinra), JAK inhibition (eg, tofacitinib, upadacitinib, baricitinib), or other biologic immunomodulatory agent within 28 days prior to screening

• Receipt of any biologic B cell-depleting therapy (eg, rituximab, ocrelizumab, obinutuzumab, ofatumumab, inebilizumab) in the 6 months prior to screening; receipt of such a B cell-depleting agent in the period 6-12 months prior to screening is exclusionary unless B cell counts have returned to ≥ LLN

• History of venous thromboembolism (VTE) or an increased risk for VTE

• Current smoking

• Estimated glomerular filtration rate < 30 mL/min/1.73 m2 by Modification of Diet in Renal Disease Study (MDRD) equation

• Blood tests at screening that meet any of the following criteria:

  • Hemoglobin < 7.5 g/dL
  • Neutrophils < 1000/mm3
  • Absolute lymphocyte count < 500/mm3
  • Platelets < 100 x 109/L

• Subjects with the following abnormal liver function tests:

  • Aspartate aminotransferase (AST) > 2x ULN
  • Alanine aminotransferase (ALT) > 2x ULN
  • Total bilirubin (TBL) > 2x ULN unless AST, ALT, and hemoglobin are within central laboratory normal range and the patient has a known history of Gilbert syndrome

• Active, clinically significant infection at the time of Screening

• Active malignancy or history of malignancy that was active within the last 5 years, except as follows:

  • In situ carcinoma of the cervix following apparently curative therapy > 12 months prior to screening,
  • Cutaneous basal cell or squamous cell carcinoma following apparently curative therapy, or
  • Prostate cancer treated with radical prostatectomy or radiation therapy with curative intent > 3 years prior to screening and without known recurrence or current treatment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
baricitinib + steroid-sparing drug +/- glucocorticoid taper	Baricitinib (LY3009104) 4 mg	* Participants will be treated with baricitinib 4 mg daily for up to 16 weeks in combination with a background steroid sparing medication * Participants who are on steroids at the time of enrollment will continue the steroid at a dose of prednisone (or equivalent) ≤ 20mg PO daily at Baseline and complete an 8 week taper of their steroid medication per a standardized protocol

Primary Outcome Measures

Name	Time	Method
Proportion of patients with resolution of cardiac FDG uptake on PET-CT	From baseline to end of treatment at 16 weeks	Resolution of FDG uptake will be determined by the consensus of two blinded nuclear medicine radiologists, in accordance with current SNMMI and ASNC guidelines

Secondary Outcome Measures

Name	Time	Method
Percent change in FDG avidity (SUVmax) in the cardiac lesion with greatest FDG avidity on PET-CT	From baseline to 8 weeks and end of treatment at 16 weeks
Percent change in total cardiac metabolic activity on FDG PET-CT	From baseline to 8 weeks and end of treatment at 16 weeks	Total cardiac metabolic activity is total lesion glycolysis within the heart
Proportion of patients with resolution of extracardiac FDG uptake on PET-CT	From baseline to 8 weeks and end of treatment at 16 weeks
Percent change in FDG avidity (SUVmax) in up to six extracardiac lesions on PET-CT	From baseline to 8 weeks and end of treatment at 16 weeks
Percent change in total extracardiac metabolic activity on FDG PET-CT	From baseline to 8 weeks and end of treatment at 16 weeks	Total extracardiac metabolic activity is total lesion glycolysis of extracardiac disease
Proportion of patients with resolution of cardiac FDG uptake on PET-CT	From baseline to 8 weeks and end of follow-up at 28 weeks
Change in sarcoidosis disease activity assessment	From baseline to 8 weeks and end of treatment at 16 weeks	Sarcoidosis disease activity assessed with King's Sarcoidosis Questionnaire. Total score range: 0 to 100, with 100 indicating the highest quality of life
Change in fatigue assessment	From baseline to 8 weeks and end of treatment at 16 weeks	Fatigue assessed with FACIT-F. Total score range: 0-52, lower scores correspond with more fatigue
Change from Baseline in Physician Disease Activity Visual Analogue Scale (VAS)	From baseline to 8 weeks and end of treatment at 16 weeks	Physician rates patient's disease on a 100 mm VAS. Score range: 0 to 100, higher scores correspond to worse disease state
Change from Baseline in Patient Disease Activity Visual Analogue Scale (VAS)	From baseline to 8 weeks and end of treatment at 16 weeks	Patient rates their disease on a 100 mm VAS. Score range: 0 to 100, higher scores correspond to worse disease state
Changes in ACE laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Changes in high-sensitivity troponin I laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Changes in NT-proBNP laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Changes in total IgG laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Changes in ESR laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Changes in CRP laboratory assessment	From baseline to 8 weeks and end of treatment at 16 weeks
Number of participants with safety endpoints of interest	From screening to end of follow-up at 28 weeks	Safety endpoints of interest include hospitalization for cardiac events, implantation of a left ventricular assist device (LVAD), cardiac transplantation, mortality

Trial Locations

Locations (1)

Stanford University; 🇺🇸 Palo Alto, California, United States