Baricitinib in CPPD - the BAPTIST Study

Launched by I.R.C.C.S OSPEDALE GALEAZZI-SANT'AMBROGIO · Jan 6, 2025

Keywords

ClinConnect Summary

The BAPTIST Study is a clinical trial exploring whether a medication called baricitinib can help treat a condition known as Calcium Pyrophosphate Deposition Disease (CPPD), which causes joint inflammation and pain. The main goal of this study is to see if baricitinib can reduce swelling in the joints and improve ultrasound results, which look for signs of calcium crystal buildup and joint inflammation. Participants will be compared to others receiving different treatments like steroids or other medications commonly used for CPPD.

To join the study, participants need to be adults aged 55 and older who meet specific health criteria for CPPD. This includes those who have experienced joint issues typical of this condition. Women must be postmenopausal, and male participants need to take precautions to avoid fathering a child during the trial. If eligible, participants can expect to receive baricitinib or one of the comparison treatments while closely monitored by healthcare professionals. It's important to note that the study is not currently recruiting participants, so those interested will need to wait until it begins.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Signed Informed Consent;
• • Male and female patients aged ≥55 years;
• • Patients that according to the investigator's judgement will benefit from the proposed treatments (favourable benefit/risk profile)
• • Menopause for women;(no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a high follicle stimulating single measurement is insufficient.);
• * Male patients must avoid having a child during the trial and must use one of the highly effective methods of contraception or sexual abstinence or have a menopause partner (no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a high follicle stimulating single measurement is insufficient). Contraception methods include:
• • Total abstinence (when this is in line with the preferred and usual lifestyle of the subject). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
• • Sterilization of the female partner (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy or tubal ligation at least six weeks before the partner enrollment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow-up hormone level assessment
• • Male sterilization (vasectomy) at least 6 months prior to screening
• • Barrier methods of contraception: Condom or Occlusive cap (diaphragm or cervical/vault caps).
• • The female partner use oral, (estrogen and progesterone), injected or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy (failure rate \<1%), for example hormone vaginal ring or transdermal hormone contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS)
• • Patients fulfilling the 2023 ACR/EULAR classification criteria for CPPD disease;
• • Patients with feasibility of synovial biopsy at the knee or wrist joint;
• * Patients with CPPD clinical presentation that may be:
• • Subset 1: patients with prevalent polyarticular involvement of the small joints and tendons of hands and wrists (rheumatoid-like subset). Patients that present with prevalent inflammatory involvement of the hands and wrists (joints and/or tendons), with or without acute attacks of arthritis of the large joints, will be included in this group. Inclusion criteria will be joint effusion and/or synovitis of the II and/or III metacarpal phalangeal (MCP) joint of at least one hand, tenosynovitis of at least 1 tendon of one hand or wrist, hyperostosis of the II and/or III MCP head;
• • Subset 2: patients with prevalent involvement of the large joints (oligoarthritis). Patients with recurrent/persistent effusion in one or more large joints (independently of the presence and grade of OA), not responsive to a single injection of steroid and white cell count in joint synovial fluid that is more than 2000 cells/mm3 and/or patients with acute monoarticular arthritis, with more than 3 attacks in one joint in the last 12 months, will be included in this group.
• Exclusion Criteria:
• • Patients positive at anticitrullinated positive antibodies (ACPA), any titre;
• • Patients affected by seronegative arthritis or other conditions that may be responsible of arthritis (i.e. gout, rheumatic polymyalgia, etc);
• • Patients that refuse synovial biopsy or present contraindications, according to investigator's judgement, including (but not limited to) increased risk for bleeding (platelet count \<100000 or use of anticoagulants), allergy to local anesthetics, suspicion of septic arthritis;
• • Patients with history of malignancy or lymphoproliferative disease; or have signs or symptoms suggestive of possible lymphoproliferative disease, including lymphadenopathy or splenomegaly; or have active primary or recurrent malignant disease; or have been in remission from clinically significant malignancy for \< 5 years;
• • Patients with cervical carcinoma in situ, basal cell carcinoma or squamous cell carcinomas who have had active disease within 3 years of screening for this study;
• • Patients with active, untreated, acute or chronic infection (such as untreated tuberculosis), or immunocompromised to an extent that such that participation in the study would pose an unacceptable risk to the subject. Patients with treated infections such as latent tuberculosis after completion of the appropriate therapy are not excluded;
• • Patients with clinically serious infection or that have received intravenous antibiotics for an infection, within 4 weeks of randomization;
• • Patients with active viral infection that, based on the investigator\'s clinical assessment, makes the patient an unsuitable candidate for the study;
• • Patients with serology suggestive for active or chronic hepatitis B or hepatitis C infection; anti-HCV, anti-HBs, anti-HBc antibodies and HBcAg, HBsAg will be tested. Patients that will result positive for anti-HCV and/or HBcAg and/or HBsAg and/or anti-HBc antibodies will be excluded from the study. Patients who are positive for both anti-HBc and antiHBs, but negative for HBcAg and HBsAb could be enrolled.
• • Patients with symptomatic herpes zoster infection within 12 weeks of screening or recurrent or disseminated (even a single episode) herpes zoster;
• • Patients with a history of disseminated opportunistic infections (e.g., listeriosis and histoplasmosis);
• • Patients with a history of venous thromboembolism (VTE), or are considered at high risk for VTE as deemed by the investigator
• • Patients who are currently on immunosuppressive therapies or have not discontinued them for at least 4 weeks;
• • Patients with clinically significant (per investigator\'s judgement) drug or alcohol abuse within the last 6 months preceding the baseline visit;
• • Patients with any major surgery within 8 weeks prior to baseline or requiring major surgery during the study, which in the opinion of the investigator would pose an unacceptable risk to the patient;
• • Patients with recent (within past 6 months) cerebrovascular accident, myocardial infarction, coronary stenting and uncontrolled hypertension (confirmed systolic blood pressure \>160 mmHg or diastolic blood pressure \>100 mm Hg); patients with less recent major cardiovascular events (\> 6 months) will be thoroughly assessed for cardiovascular risk taking under consideration all possible risk factors and the disease phenotype and activity and will be included only in case of favourable benefit/risk ratio according to the principal investigators judgement.
• • Patients with presence of significant uncontrolled respiratory, hepatic, renal, endocrine, hematologic, neurologic, or neuropsychiatric disorders, or abnormal laboratory screening values that, in the opinion of the investigator, pose an unacceptable risk to the patient if participating in the study or of interfering with the interpretation of the data;
• • Patients with clinical laboratory test results at screening that are outside the normal reference range of the population and are considered clinically significant, or have any of the following specific abnormalities: neutrophil count \<1500 cells/µL, lymphocyte count \<500 cells/µL, platelet count \<100,000 cells/µL, aspartate transaminase (AST) or alanine aminotransferase (ALT) \> 2 times the upper limit of normal, haemoglobin \<10 g/dL for male and female subjects, eGFR \< 30 mL/min;
• • Patients with any other condition that precludes him/her from following and completing the protocol, in the opinion of the investigator;
• • Patients currently enrolled in or discontinued from a clinical trial involving an investigational product or non-approved use of a drug or device within the last 4 weeks or a period of at least 5 half-lives of the last administration of the drug, whichever is longer, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study.
• • Hypersensitivity to the active substance or to any of the excipients