OBJECTIVES

: To compare the efficacy of filgotinib with other agents for treatment of moderately to severely active ulcerative colitis in biologic-experienced patients using a systematic review and network meta-analysis.

METHODS

: A systematic review was conducted in November 2020 for randomized trials and post hoc analyses of patients with ulcerative colitis treated with anti-TNF agents, vedolizumab, tofacitinib, ustekinumab or filgotinib. Included studies reported induction or maintenance efficacy. Analyses were conducted for Mayo Clinic Score (MCS) response, remission and mucosal healing in biologic-experienced patients. The induction phases were consistent in design and a standard approach to induction results could be undertaken. Owing to heterogeneity in the design of the included maintenance studies, maintenance data from trials with treat-through response designs were recalculated to correspond with trials with rerandomized arms. A Bayesian approach to estimation was adopted whereby posterior distributions for treatment effects were estimated using a generalized linear model framework to synthesize data.

RESULTS

: A total of nine trials were included. In the induction phase, patients on all treatments except adalimumab had a statistically significantly greater probability of achieving MCS response, remission and mucosal healing than patients on placebo. Patients receiving filgotinib 200mg had numerically higher probabilities of achieving clinical response or remission than patients on any of the comparators; however, differences were not statistically significant. At the end of the maintenance phase, patients on all treatments except ustekinumab 90mg Q12W had a statistically significantly greater probability of achieving MCS response, remission and mucosal healing than patients on placebo. However, there were no statistically significant differences between active therapies.

CONCLUSIONS

: In biologic-experienced patients, filgotinib was associated with a numerically higher likelihood of MCS response and remission in the induction phase, and statistically similar efficacy in the maintenance phase, compared with other treatments. Filgotinib provides an efficacious option for patients with ulcerative colitis.