Baricitinib for Depression in People With HIV

Recruiting in Palo Alto (17 mi)

+2 other locations

Overseen by Jennifer Felger, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Emory University

Must be taking: Antiretroviral therapy

Must not be taking: Immunosuppressants, NSAIDs, JAK inhibitors

Disqualifiers: Age, Pregnancy, Cardiovascular disease, others

Prior Safety Data

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial tests whether the anti-inflammatory drug baricitinib can help people with HIV and depression by reducing inflammation. The study focuses on patients who have high inflammation and are already on effective HIV treatment. Researchers want to see if lowering inflammation can improve brain functions related to pleasure and movement, potentially easing depressive symptoms.

Will I have to stop taking my current medications?

The trial requires that you either stop taking antidepressants or other psychotropic medications (like mood stabilizers or antipsychotics) for at least 4 weeks before starting, or be on a stable dose for at least 4 weeks. If you're taking fluoxetine, you need to stop it for 8 weeks before starting the trial.

What data supports the effectiveness of the drug Baricitinib for depression in people with HIV?

Antidepressant medication has been shown to be effective in treating depression among HIV-positive individuals, with a significant pooled effect size in studies. However, the effectiveness of Baricitinib specifically for depression in this population is not directly addressed in the available research. ^{1 2 3 4 5}

How does the drug Baricitinib differ from other treatments for depression in people with HIV?

Baricitinib is unique because it is primarily used for conditions like rheumatoid arthritis and works by inhibiting specific enzymes (Janus kinases) involved in inflammation, which might offer a novel approach to treating depression in people with HIV by potentially addressing inflammation-related pathways that contribute to depression. ^{1 2 3 6 7}

Research Team

Andrew H Miller, MD

Principal Investigator

Emory University

Jennifer Felger, PhD

Principal Investigator

Emory University

Eligibility Criteria

This trial is for men and women with HIV who are stable on treatment, have depression with significant anhedonia (lack of pleasure including low motivation or feeling like everything is an effort), and high inflammation. They must not be pregnant or breastfeeding, should agree to use contraception, have a CD4+ count over 350, no major health issues like heart failure or untreated infections, and not be on certain medications.

Inclusion Criteria

You have been diagnosed with HIV

Have you been on stable antiretroviral therapy (ART) regimen for more than 1 year?

Are you 18 years of age or older?

Exclusion Criteria

Are you pregnant, actively trying to become pregnant, or are you breastfeeding?

Do you have any reason you cannot have an MRI scan (e.g. pacemaker)?

Have you ever been diagnosed or treated for an autoimmune disorder or cancer (excluding skin cancer)?

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the anti-inflammatory drug baricitinib or a placebo for 10 weeks

10 weeks

Baseline visit and week 10 visit

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Baricitinib (Anti-inflammatory)
• Placebo (Other)

Trial Overview The study tests if the anti-inflammatory drug baricitinib affects depressive symptoms in people with HIV compared to a placebo. Participants will undergo medical assessments, neurocognitive testing, brain scans (fMRI), and optional spinal taps over approximately 3.5 months.

Participant Groups

Group I: Baricitinib Experimental Treatment 1 Intervention

Participants will be randomized to receive 10 weeks of treatment with baricitinib.

Group II: Placebo Placebo Group 1 Intervention

Participants will be randomized to receive 10 weeks of treatment with placebo.

Who Is Running the Clinical Trial?

Emory University

Lead Sponsor

Trials

1,735

Recruited

2,605,000+

Dr. R. Donald Harvey

Emory University

Chief Medical Officer

MD from Emory University School of Medicine

Dr. George Painter

Emory University

Chief Executive Officer since 2013

PhD in Synthetic Organic Chemistry from Emory University

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Dr. Joshua A. Gordon

National Institute of Mental Health (NIMH)

Chief Executive Officer since 2016

MD, PhD

Dr. Shelli Avenevoli

National Institute of Mental Health (NIMH)

Chief Medical Officer

PhD

Findings from Research

Patients with HIV should be routinely screened for major depression, as accurate diagnosis is crucial to avoid harmful exposure to inappropriate psychotropic medications.

Antidepressants used to treat major depression in HIV-infected patients are similar to those used in the general population, and while no specific antidepressant is superior, patient adherence is key, influenced by the side effects of these medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drug treatment of depression in HIV-positive patients : safety considerations. Pieper, AA., Treisman, GJ.[2022]

Antidepressant medications have been found to be effective in treating depression among HIV-positive individuals, with a pooled effect size of 0.57 based on a systematic review of 7 studies involving 494 subjects.

However, the studies showed significant variability in results, largely influenced by placebo responses, and highlighted a concerning lack of representation of women and minorities, suggesting that future research should focus on these underrepresented groups to improve generalizability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of antidepressant medication among HIV-positive individuals with depression: a systematic review and meta-analysis. Himelhoch, S., Medoff, DR.[2022]

In a study of 881 HIV-infected veterans, 46% exhibited significant depressive symptoms, but these symptoms did not correlate with illness severity or survival rates after adjusting for HIV symptoms.

HIV symptoms were found to be significantly associated with both the severity of illness and survival, indicating that healthcare providers should prioritize addressing HIV symptoms independently of any depressive symptoms present.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical importance of HIV and depressive symptoms among veterans with HIV infection. Kilbourne, AM., Justice, AC., Rollman, BL., et al.[2019]

The 10-item CES-D scale has been shown to be a reliable and valid tool for measuring depressive symptoms in HIV-positive patients, with a high correlation (0.97) to the original 20-item scale.

This shortened scale demonstrated excellent internal consistency (Cronbach α=0.88) and predictive accuracy, with sensitivity at 91% and specificity at 92%, making it effective for identifying depression in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. Zhang, W., O'Brien, N., Forrest, JI., et al.[2022]

The study involved 304 HIV-infected adults with major depressive disorder and tested a measurement-based care (MBC) intervention, which led to significant improvements in depressive severity and increased depression-free days, although it did not enhance antiretroviral adherence or other HIV outcomes.

Participants in the MBC group experienced a clinically significant reduction in depressive symptoms and a higher rate of depression remission compared to usual care, suggesting that integrating depression management into HIV care can effectively reduce depression morbidity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. Pence, BW., Gaynes, BN., Adams, JL., et al.[2022]

Among HIV-infected individuals on Medicaid, women were more likely to be diagnosed with depression, while African Americans were less likely, highlighting disparities in mental health diagnosis.

Depressed patients receiving antidepressant treatment not only had better access to antiretroviral therapy but also experienced a 24% reduction in monthly healthcare costs compared to those not treated with antidepressants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. Sambamoorthi, U., Walkup, J., Olfson, M., et al.[2019]

HIV infection, despite improved life expectancy due to HAART, can lead to significant neurological disturbances, with depression being the most common neuropsychiatric disorder among patients, affecting their quality of life and adherence to treatment.

The mechanisms by which HIV predisposes individuals to depression include chronic inflammation, neurotoxicity, and reduced levels of brain-derived neurotrophic factor, highlighting the need for targeted pharmacological treatments to address these issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Human immunodeficiency virus-associated depression: contributions of immuno-inflammatory, monoaminergic, neurodegenerative, and neurotrophic pathways. Del Guerra, FB., Fonseca, JL., Figueiredo, VM., et al.[2021]

References

1. New Zealand pubmed.ncbi.nlm.nih.gov

Drug treatment of depression in HIV-positive patients : safety considerations. [2022]

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

Efficacy of antidepressant medication among HIV-positive individuals with depression: a systematic review and meta-analysis. [2022]

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

Clinical importance of HIV and depressive symptoms among veterans with HIV infection. [2019]

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

Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. [2022]

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

The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. [2022]

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

Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. [2019]

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

Human immunodeficiency virus-associated depression: contributions of immuno-inflammatory, monoaminergic, neurodegenerative, and neurotrophic pathways. [2021]