Filgotinib in the treatment of Ulcerative colitis: lessons learned from randomized trial to real-world studies

Introduction Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) of the colon whose treatment has evolved with novel targeted therapies. Filgotinib (FILGO) is a small molecule that preferentially inhibits Janus kinase 1 (JAK1). The SELECTION trial established the efficacy of FILGO for induction and maintenance of remission in UC, and subsequent real-world studies have confirmed its effectiveness. However, real-world evidence remains limited by relatively small sample sizes and short follow-up periods. Several studies have also explored the ability of FILGO to improve health-related quality of life (HRQoL).Areas covered This review examines and summarizes current evidence and recent advances regarding filgotinib as a therapeutic option for UC, including efficacy, safety, and real-world effectiveness. PubMed, Embase, and Scopus were searched from database inception through June 2026, supplemented by screening the reference lists of identified articles.Expert opinion FILGO is a Janus kinase inhibitor (JAKi) with a favorable efficacy and effectiveness profile, as demonstrated by pivotal trials and real-world (RW) studies. Available evidence also suggests a favorable safety profile within the JAK inhibitor class, although randomized head-to-head comparisons are lacking. Further long-term RW studies are needed to confirm these findings and refine the positioning of FILGO in clinical practice.