Background: Autosomal dominant hyper-IgE syndrome (HIES), also called Job syndrome, is a genetic disorder that affects the immune system. It can cause skin and lung infections and problems with blood vessels, connective tissues, and bones. People with HIES often have lupus-like disease or atopic dermatitis (skin rash). Researchers want to know if a drug approved to treat other immune system diseases (baricitinib) can help people with HIES. Objective: To test baricitinib in people with HIES with lupus-like disease or skin rash. Eligibility: People aged 12 years and older with HIES with lupus-like disease or skin rash. Design: Participants will have 5 clinic visits, 4 remote visits, and 2 phone visits in 9 months. Participants will be screened. They will have a physical exam with blood and urine tests. They will have tests of the speed and pressure of blood flow through their body: Blood pressure cuffs will be placed on each arm and leg; electrodes will be placed on the wrists and a microphone on the chest. The study has a 3-month lead-in period. Participants will not take the study drug during this time. They will continue with their usual medical care. They will have 2 phone calls with the study team. Baricitinib is a tablet taken by mouth. Participants will take 1 or 2 tablets by mouth every day for 6 months. They will start with a low dose and may increase to a higher dose. Blood and urine tests will be repeated during each study visit. Other tests may also be repeated during some visits. A skin sample may also be taken....
Study Description: This is an open-label, dose-titration, pilot trial to assess the safety of the Janus-associated kinase (JAK) inhibitor baricitinib in individuals with Job s syndrome with lupus-like features and/or atopic dermatitis (AD). Eligible participants will complete screening 3 months prior to the start of the trial and keep track of their infections and eczema to monitor Job s disease activity and ensure disease stability prior to initiation of baricitinib treatment. Those with stable disease will proceed to open-label treatment with baricitinib for 180 days. Primary Objective: To determine the safety and tolerability of JAK inhibitor treatment (baricitinib) in patients with Job s syndrome with lupus-like disease and/or AD. Secondary Objectives: 1. To assess changes in Candida and/or bacterial infections. 2. To evaluate the effect of baricitinib on lupus-like symptoms. 3. To evaluate the effect of baricitinib on AD. 4. To investigate the effect of baricitinib on quality of life (QOL). Exploratory Objectives: To investigate the effect of baricitinib on improving histologic and immunologic abnormalities in blood and affected organs and tissues. Primary Endpoints: 1\. Incidence of serious adverse events (SAEs), adverse events (AEs) requiring study drug discontinuation. Secondary Endpoints: 1. Incidence of Candida and/or bacterial infections. 2. Mean change in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score from day -90 to day 0 and then from day 0 to days 90 and 180. 3. Mean change in Eczema Area and Severity Index (EASI) score from day -90 to day 0 and then from day 0 to days 90 and 180. 4. Mean change in Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score from day -90 to day 0 and then from day 0 to days 90 and 180. 5. Mean change in the Physician Global Assessment (PGA) score from day -90 to day 0 and then from day 0 to days 90 and 180. 6. Mean change in the 36-Item Short Form Survey (SF-36) score (adults) from day -90 to day 0 and then from day 0 to days 90 and 180. 7. Mean change in the Patient Reported Outcomes Measurement Information System (PROMIS) score from day -90 to day 0 and then from day 0 to days 90 and 180. 8. Mean change in the Dermatology Life Quality Index (DLQI) score (adults) from day -90 to day 0 and then from day 0 to days 90 and 180. 9. Mean change in the Children s Dermatology Life Quality Index (CDLQI) score (pediatrics) from day -90 to day 0 and then from day 0 to days 90 and 180. 10. Mean change in the Pediatric Quality of Life Inventory (PedsQL) score (pediatrics) from day -90 to day 0 and then from day 0 to days 90 and 180. Exploratory Endpoints: 1. Changes in serum cytokines and chemokines between day -90 to day 0 and then day 0 to days 90 and 180. 2. Changes in neutrophil extracellular trap (NET) complexes between days -90 to day 0 and then from day 0 to days 90, and 180. 3. Changes in Transcriptional alterations and pathway analysis using scRNAseq on peripheral blood mononuclear cells (PBMCs) and neutrophils between days -90 to day 0 and then from day 0 to days 90, and 180. 4. Changes in skin biopsy - histopathology and anatomic pathology from day 0 to day 180. 5. Changes in immunophenotyping between days -90 to day 0 and then from day 0 to days 90, and 180. 6. Changes in phospho-signal transducer and activator of transcription (STAT) flow cytometry between days -90 to day 0 and then from day 0 to days 90, and 180. 7. Changes in arterial stiffness- assessment of vascular functions (assessed via cardio-ankle vascular index \[CAVI\]) between day -90 and day 0, and then between day 0 and days 90 and 180. 8. Changes in autoantibody levels from day -90 to day 0 and then from day 0 to days 90 and 180. 9. Changes in skin microbiome over the 180-day treatment period. 10. Changes in serum metabolomics from day -90 to day 0 and then from day 0 to days 90 and 180. 11. Changes in serum proteomics from day -90 to day 0 and then from day 0 to days 90 and 180.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
The planned duration of baricitinib treatment is 180 days. The treatment period will begin on Day 0 at dose level 1 (2 mg once daily) and will continue for 90 days. Following evaluation of safety, participants will be titrated to dose level 2 (4 mg once daily) provided the investigator determines it is safe and appropriate to do so. Study participants will continue on dose level 2 for 90 days.
National Institutes of Health Clinical Center
Bethesda, Maryland, United States
RECRUITINGIncidence of SAEs, AEs requiring study drug discontinuation.
To determine the safety and tolerability of JAK inhibitor treatment (baricitinib) in patients with Job s syndrome with lupus-like disease and/or AD.
Time frame: Through end of study
Incidence of Candida and/or bacterial infections.
To assess changes in Candida and/or bacterial infections
Time frame: Through end of study
Mean change in CLASI score from day -90 to day 0 and then from day 0 to days 90 and 180.
To evaluate the effect of baricitinib on lupus-like features.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in EASI score from day -90 to day 0 and then from day 0 to days 90 and 180.
To evaluate the effect of baricitinib on AD.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in SLEDAI score from day -90 to day 0 and then from day 0 to days 90 and 180.
To evaluate the effect of baricitinib on lupus-like features.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the PGA score from day -90 to day 0 and then from day 0 to days 90 and 180.
To evaluate the effect of baricitinib on lupus-like features and AD.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the SF-36 score (adults) from day -90 to day 0 and then from day 0 to days 90 and 180.
To investigate the effect of baricitinib on QOL.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the PROMIS score from day -90 to day 0 and then from day 0 to days 90 and 180.
To investigate the effect of baricitinib on QOL.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the DLQI score (adults) from day -90 to day 0 and then from day 0 to days 90 and 180.
To investigate the effect of baricitinib on QOL.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the CDLQI score (pediatrics) from day -90 to day 0 and then from day 0 to days 90 and 180.
To investigate the effect of baricitinib on QOL.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
Mean change in the PedsQL score (pediatrics) from day -90 to day 0 and then from day 0 to days 90 and 180.
To investigate the effect of baricitinib on QOL.
Time frame: From day -90 to day 0 and then from day 0 to days 90 and 180
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