S1926 Efficacy of Filgotinib in Patients With Ulcerative Colitis: A Systemic Review and Meta-Analysis

Introduction: Filgotinib, a novel Janus kinase-1 (JAK1) selective inhibitor, reduces inflammation by disrupting the signaling pathways of immune cells in response to cytokines. It has recently been approved as therapy for moderate-to-severe Ulcerative Colitis (UC). It has improved drug clearance and is effective in both biologic-naïve as well as biologic-failed patients (TNF antagonists, Vedolizumab, etc. used as first-line treatment) and has been studied through clinical trials such as the SELECTION trial. In this review, we assess the efficacy of Filgotinib through the clinical and pathological regression of UC. Methods: The review conducted follows PRISMA guidelines. PUBMED, Google Scholar and Science-Direct were extensively searched using a search term to retrieve articles. Articles which included the assessment of complete remission of UC following Filgotinib therapy and standard treatment were included. The data was analysed using the Meta, Metadata and the Metafor packages of R Studio. The proportion of the Odds Ratio (OR) of complete remission of UC following Filgotinib therapy compared to standard care/Placebo was assessed as our primary outcome. The pooled ratio of complete remission of UC following different doses was assessed as secondary outcomes. The Mantel-Haenszel method and the Inverse variance method were utilised to analyse the odds ratio. Results: The study includes a total of 10 papers with 2710 subjects receiving Filgotinib therapy and 2130 patients under standard care/placebo for UC. The OR of Complete remission of Ulcerative Colitis was not statistically significant in both groups indicating similar clinical efficacy in both groups.(odds ratio [OR] = 1.31 {0.94;1.82}), 95% CI, P < 0.01, I2 = 86%). Pooled proportion of Complete remission of UC was assessed in 2 different drug doses among induction and maintenance phases. Complete remission was achieved in 40% of the population receiving 200 mg Filgotinib therapy and 23% in the 100 mg Filgotinib therapy group. The risk of adverse events was similar in both the groups indicating similar safety index (OR = 0.8508(0.6391; 1.144), I2 = 29%, P = 0.22). Conclusion: This review indicates that a higher dose of Filgotinib may lead to a higher probability of clinical regression without any significant rise in the adverse effects. Studies focusing heavily on a lower dose of Filgotinib are still ongoing and its efficacy is yet to be analysed completely, however this review suggests that current dosage of 200 mg may be safely continued for the treatment of ulcerative colitis.