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Baricitinib for relapsing giant cell arteritis: a prospective open-label 52-week pilot study

Matthew J Koster1, Cynthia S Crowson2, Rachel E Giblon2

  • 1Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA koster.matthew@mayo.edu.

Annals of the Rheumatic Diseases
|February 22, 2022
PubMed
Abstract

Insights

Baricitinib effectively treated relapsing giant cell arteritis (GCA), allowing most patients to discontinue glucocorticoids. This JAK inhibitor shows promise for GCA management, warranting further clinical trials.

Area of Science:

  • Immunology
  • Rheumatology
  • Pharmacology

Background:

  • Preclinical models show Janus kinase (JAK) inhibition suppresses T cells in vascular inflammation.
  • Prospectively investigating JAK inhibition in giant cell arteritis (GCA) patients is lacking.

Purpose of the Study:

  • To evaluate the safety and efficacy of baricitinib in patients with relapsing GCA.
  • To assess the potential for glucocorticoid (GC) discontinuation with baricitinib treatment.

Main Methods:

  • A prospective, open-label, pilot study involving 15 patients with relapsing GCA.
  • Patients received baricitinib (4 mg/day) with a tiered GC entry and accelerated taper regimen.
  • Disease activity and adverse events were monitored over 52 weeks.

Main Results:

  • 14 out of 15 patients completed 52 weeks of baricitinib treatment.
  • 93% of patients experienced adverse events, most commonly infections and gastrointestinal issues.
  • Only 7% of patients relapsed, and 13 patients achieved complete steroid discontinuation and remission.

Conclusions:

  • Baricitinib (4 mg/day) was well-tolerated and facilitated GC discontinuation in most relapsing GCA patients.
  • This proof-of-concept study supports further investigation of JAK inhibition for GCA.
  • Larger randomized trials are necessary to confirm baricitinib's utility in GCA treatment.
Keywords:
giant cell arteritissystemic vasculitistherapeutics

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