OBJECTIVES: For rheumatoid arthritis (RA) patients who have an inadequate response to biologic disease-modifying antirheumatic drugs (bDMARDs), treatment options include switching to another bDMARD or to newer targeted synthetic DMARDs (tsDMARDs). Filgotinib, a tsDMARD which selectively inhibits JAK1, has demonstrated efficacy and safety in the FINCH2 trial. Our objective was to perform a systematic literature review and network meta-analysis (NMA) to compare the efficacy of filgotinib + conventional synthetic DMARDs (csDMARDS) to alternative treatments in moderate-severe RA patients with an inadequate response to bDMARDs (bDMARD-IR).

METHODS: Studies reporting American College of Rheumatology (ACR) response were systematically identified and selected for NMA. To estimate the relative efficacy of the therapies, a Bayesian hierarchical NMA was performed using a fixed effects single-model approach that considers ACR response as a single endpoint, rather than split by ACR20/50/70 criteria. Comparative efficacies were reported as median values with 95% credible intervals (CrI) on the probit scale (non-significant results overlap 0).

RESULTS: A total of 11 trials, were eligible for NMA. Based on ACR response, all bDMARD and tsDMARD were found to be highly efficacious compared to csDMARDs. Filgotinib + csDMARDs (hereinafter referred to as filgotinib) significantly outperformed csDMARDs alone at 12 weeks (100mg: 0.6261; 0.3681 – 0.8942; 200mg: 0.881; 0.623 – 1.147), and 24 weeks (100mg: 0.5486; 0.2875 – 0.818; 200mg: 0.912; 0.645 – 1.183). Filgotinib (200mg) demonstrated statistically significant superiority over sarilumab + csDMARDs (150mg q2w) in ACR response at 12 weeks (0.3723; CrI 0.012 – 0.723). When comparing bDMARDs/tsDMARDs to each other, no intervention was significantly more effective at either 12 or 24 weeks.

CONCLUSIONS: Filgotinib is more effective than csDMARDs and has a similar efficacy to other treatments in bDMARD-IR patients. Filgotinib provides another efficacious option for patients who may need to switch from a typical biologic to the newer JAK inhibitor class.