Gusacitinib for Lupus

Overseen By Yenealem Temesgen-Oyelakin, R.N.

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Must not be taking: Biologics, Live vaccines, Antibiotics, others

Disqualifiers: Pregnancy, Cancer, Heart failure, others

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Trial Summary

What is the purpose of this trial?

Background: Systemic lupus erythematosus (SLE), also called lupus, is a disease that causes the body s immune system to attack healthy tissue. Lupus causes swelling and inflammation in the skin, skin, joints, kidneys, brain, blood vessels, and other organs. There is no cure for lupus. Current treatments do not help everyone and may have adverse effects. Better treatments are needed. Objective: To test a study drug (Gusacitinib) in people with lupus. Eligibility: People aged 18 years and older with lupus. Design: Participants will be screened. They will have a physical exam with blood and urine tests and a test of their heart function. They will have a chest X-ray. They will have tests that use blood pressure cuffs to measure blood flow and pressure throughout the body. Participants will have 9 clinic visits and 6 phone visits over about 7 months. The study has 3 parts. Part 1: Gusacitinib is a tablet taken by mouth. Participants will be divided into 3 groups. One group will receive the study drug, and a second group will get a placebo. The placebo looks like the study drug but does not contain any medicine. Both of these groups will take their tablets once a day for 12 weeks. The third group will continue to take their usual medications for lupus throughout the study. Part 2: All participants who took the study drug or placebo in part 1 will take the study drug once a day for 12 weeks. Part 3: All participants who took the study drug will stop taking it for 4 weeks.

Do I have to stop taking my current medications for the trial?

It depends on the medication. If you're on immunosuppressants, you'll need to stop them 2 weeks before starting the study drug and remain off them during the trial. If you're on glucocorticoids or hydroxychloroquine, you can continue them if the doses are stable. Other medications like those for diabetes, hypertension, or statins can also be continued if stable. The protocol does not specify for other medications, so check with the study team.

What data supports the idea that Gusacitinib for Lupus is an effective treatment?

The available research does not provide any specific data on Gusacitinib for treating Lupus. Instead, it discusses other drugs like Baricitinib, Pacritinib, Deucravacitinib, and GSK2586184. These studies focus on their effects on Lupus, but none mention Gusacitinib. Therefore, there is no data here to support the effectiveness of Gusacitinib for Lupus. ^{1 2 3 4 5}

What safety data is available for Gusacitinib in treating lupus?

The provided research does not contain specific safety data for Gusacitinib (also known as ASN-002, ASN002, EN-3351, EN3351, WHO 10976) in the treatment of lupus. The studies mentioned focus on other treatments such as GSK2586184, baricitinib, deucravacitinib, and voclosporin, which are different drugs. Therefore, no relevant safety data for Gusacitinib is available in the provided research. ^{3 4 5 6 7}

Is the drug Gusacitinib a promising treatment for Lupus?

The information provided does not include any specific details about Gusacitinib or its effectiveness for treating Lupus. Therefore, we cannot determine if Gusacitinib is a promising treatment for Lupus based on the given research articles. ^{1 3 8 9 10}

Research Team

Sarfaraz A Hasni, M.D.

Principal Investigator

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Eligibility Criteria

This trial is for adults over 18 with lupus, a condition where the immune system attacks healthy tissue. Participants will undergo various tests including physical exams, blood and urine analysis, heart function tests, chest X-rays, and blood flow measurements.

Inclusion Criteria

I am 18 years old or older.

I am taking 20 mg or less of prednisone (or equivalent) daily for the last 2 weeks.

I've been on a steady dose of immunosuppressants for the last 12 weeks.

Exclusion Criteria

My lupus affects my kidneys, brain, or has severely impacted another organ.

My blood counts are low and have been confirmed by tests 4 weeks apart.

A history of drug or alcohol abuse within the 6 months prior to screening

Treatment Details

Interventions

• Gusacitinib

Trial Overview The drug Gusacitinib is being tested in people with lupus. The study has three parts: initially comparing Gusacitinib to a placebo for 12 weeks; then all participants take Gusacitinib for another 12 weeks; finally, those on the drug stop it for four weeks to observe effects.

Participant Groups

Group I: Control Active Control 1 Intervention

Subjects will remain on their usual SLE medications

Group II: Placebo Placebo Group 1 Intervention

Subjects will receive a placebo that looks similar to the interventional drug.

Gusacitinib is already approved in United States for the following indications:

Approved in United States as Gusacitinib for:

• Chronic hand eczema (Fast Track designation)

Who Is Running the Clinical Trial?

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Lead Sponsor

Trials

508

Recruited

1,090,000+

Findings from Research

In a study using lupus-prone ABIN1[D485N] knock-in mice, pacritinib effectively prevented various symptoms of lupus, such as splenomegaly and elevated autoantibody levels, over a 10-week treatment period.

The results suggest that pacritinib could be a promising treatment option for managing multiorgan inflammation in lupus patients, as it reduced immune cell expansion and inflammation in multiple organs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pacritinib abrogates the lupus phenotype in ABIN1[D485N] mice. Petrova, T., Figueras-Vadillo, C., Nanda, SK., et al.[2023]

In a phase II trial involving 239 adults with systemic lupus erythematosus (SLE), baricitinib at a dose of 4 mg significantly reduced several inflammatory cytokines compared to placebo after 12 weeks, indicating its potential efficacy in managing SLE-related inflammation.

The study suggests that baricitinib may work through a multitargeted mechanism by downregulating key cytokines associated with SLE, which could lead to improved disease activity, although further research is needed to fully understand its clinical relevance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mechanism of action of baricitinib and identification of biomarkers and key immune pathways in patients with active systemic lupus erythematosus. Dörner, T., Tanaka, Y., Dow, ER., et al.[2022]

In a phase II trial involving 363 adults with active systemic lupus erythematosus (SLE), deucravacitinib significantly improved response rates compared to placebo, with 58% of patients on the 3 mg twice daily dose achieving the SLE Responder Index 4 (SRI-4) response at week 32.

The safety profile of deucravacitinib was generally acceptable, with similar rates of serious adverse events compared to placebo, although there were higher incidences of infections and skin-related issues like rash and acne in the treatment groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deucravacitinib, a Tyrosine Kinase 2 Inhibitor, in Systemic Lupus Erythematosus: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. Morand, E., Pike, M., Merrill, JT., et al.[2023]

The JAK1 inhibitor GSK2586184 was evaluated in a study involving 50 adults with systemic lupus erythematosus (SLE) over 12 weeks, but it showed no significant effect on interferon transcriptional biomarkers, leading to the study being declared futile.

Safety concerns arose during the trial, including elevated liver enzymes in six patients, which resulted in immediate cessation of dosing and indicated that GSK2586184 is not suitable for further evaluation in SLE patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety, tolerability, efficacy and pharmacodynamics of the selective JAK1 inhibitor GSK2586184 in patients with systemic lupus erythematosus. Kahl, L., Patel, J., Layton, M., et al.[2017]

Baricitinib treatment led to significant reductions in anti-dsDNA antibodies and IgG levels in patients with systemic lupus erythematosus (SLE), indicating its potential efficacy in managing this condition.

The study showed that baricitinib resulted in a rapid decrease in anti-dsDNA levels starting as early as 2 weeks, suggesting it may influence B cell activity, although further research is needed to confirm this mechanism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Baricitinib decreases anti-dsDNA in patients with systemic lupus erythematosus: results from a phase II double-blind, randomized, placebo-controlled trial. Dörner, T., van Vollenhoven, RF., Doria, A., et al.[2022]

In a safety analysis involving 1655 adult patients with systemic lupus erythematosus (SLE) treated with baricitinib for up to 3.5 years, the incidence of infections was similar across baricitinib (4 mg and 2 mg) and placebo groups, with common infections including urinary tract infections and COVID-19.

The study found no significant increase in serious infections or venous thromboembolic events associated with baricitinib treatment, indicating that its safety profile remains consistent with previous findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety profile of baricitinib in patients with systemic lupus erythematosus: an integrated analysis. Morand, E., Smolen, JS., Petri, M., et al.[2023]

Voclosporin, when combined with mycophenolate mofetil and glucocorticoids, significantly improved complete renal response in lupus nephritis patients, with 43.7% achieving this outcome compared to 23.3% in the control group, based on an integrated analysis of 534 patients from two clinical trials.

The safety profile of voclosporin was comparable to the control, with similar rates of adverse events, most of which were mild to moderate, indicating that voclosporin is a safe and effective treatment option for lupus nephritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Update on the Efficacy and Safety Profile of Voclosporin: An Integrated Analysis of Clinical Trials in Lupus Nephritis. Arriens, C., Teng, YKO., Ginzler, EM., et al.[2023]

In a 24-week phase 2 study involving 314 patients with systemic lupus erythematosus, the 4 mg dose of baricitinib significantly improved symptoms, with 67% of patients achieving resolution of arthritis or rash compared to placebo.

The safety profile of baricitinib was consistent with previous studies, with serious adverse events occurring in 10% of patients on the 4 mg dose, indicating that while effective, monitoring for side effects is important.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial. Wallace, DJ., Furie, RA., Tanaka, Y., et al.[2021]

In a 52-week phase 3 study involving 775 patients with systemic lupus erythematosus (SLE), baricitinib did not show a significant improvement in disease activity compared to placebo, with similar response rates across all treatment groups.

The safety profile of baricitinib remained consistent with previous studies, with serious adverse events occurring in 11% of the 4 mg group, 13% of the 2 mg group, and 9% of the placebo group, indicating no new safety concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-II). Petri, M., Bruce, IN., Dörner, T., et al.[2023]

In a 52-week phase 3 study involving 760 participants with active systemic lupus erythematosus (SLE), baricitinib 4 mg significantly improved disease activity compared to placebo, with 57% of patients achieving an SLE Responder Index (SRI)-4 response.

While the 4 mg dose showed efficacy, key secondary endpoints, such as glucocorticoid tapering and time to first severe flare, did not show significant differences compared to placebo, and the safety profile of baricitinib remained consistent with previous studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I). Morand, EF., Vital, EM., Petri, M., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Pacritinib abrogates the lupus phenotype in ABIN1[D485N] mice. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Mechanism of action of baricitinib and identification of biomarkers and key immune pathways in patients with active systemic lupus erythematosus. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Deucravacitinib, a Tyrosine Kinase 2 Inhibitor, in Systemic Lupus Erythematosus: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Safety, tolerability, efficacy and pharmacodynamics of the selective JAK1 inhibitor GSK2586184 in patients with systemic lupus erythematosus. [2017]

5. England pubmed.ncbi.nlm.nih.gov

Baricitinib decreases anti-dsDNA in patients with systemic lupus erythematosus: results from a phase II double-blind, randomized, placebo-controlled trial. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Safety profile of baricitinib in patients with systemic lupus erythematosus: an integrated analysis. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Update on the Efficacy and Safety Profile of Voclosporin: An Integrated Analysis of Clinical Trials in Lupus Nephritis. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-II). [2023]

10. England pubmed.ncbi.nlm.nih.gov

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I). [2023]