Filgotinib, a JAK1 Inhibitor, Modulates Disease-Related Biomarkers in Rheumatoid Arthritis: Results from Two Randomized, Controlled Phase 2b Trials

Introduction The Janus kinase (JAK) inhibitor therapeutic class has shown significant clinical benefit in the treatment of rheumatoid arthritis (RA). We sought to gain insight into the mode of action and immunological effects of filgotinib, a JAK1 selective inhibitor, in active RA by analyzing secre...

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Bibliographic Details
Published in:Rheumatology and therapy. 2020-03, Vol.7 (1), p.173-190
Main Authors: Tarrant, Jacqueline M., Galien, René, Li, Wanying, Goyal, Lovely, Pan, Yang, Hawtin, Rachael, Zhang, Wangshu, Van der Aa, Annegret, Taylor, Peter C.
Format: Article
Language:English
Subjects:
Biomarkers
Cytokines
DARWIN1
DARWIN2
Family Medicine
Filgotinib
General Practice
Internal Medicine
Medicine
Medicine & Public Health
Original Research
Orthopedics
Quality of Life Research
Rheumatoid arthritis
Rheumatology
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Summary:Introduction The Janus kinase (JAK) inhibitor therapeutic class has shown significant clinical benefit in the treatment of rheumatoid arthritis (RA). We sought to gain insight into the mode of action and immunological effects of filgotinib, a JAK1 selective inhibitor, in active RA by analyzing secreted and cell-based biomarkers key to RA pathophysiology in two phase 2b trials of filgotinib in active RA. Methods Immune cell subsets and 34 serum biomarkers were analyzed longitudinally over 12 weeks using blood samples collected from patients with active RA receiving filgotinib (100 or 200 mg once daily) or placebo (PBO) in the two phase 2b trials (DARWIN 1, on a background of methotrexate, and DARWIN 2, as monotherapy). Results Consistently across both studies, filgotinib treatment decreased multiple immune response biomarkers that have key roles in RA for immune response, and decreased markers that promote matrix degradation, angiogenesis, leukocyte adhesion, and recruitment. Filgotinib did not significantly modulate T and natural killer (NK) lymphoid subsets, but slightly increased B cell numbers after 12 weeks. Multiple correlations were observed for changes in biomarkers with disease activity score 28-CRP. MIP1β showed modest predictivity at baseline for ACR50 response at 12 weeks in the 100 mg filgotinib dose across both studies (AUROC, 0.65 and 0.67, p  
ISSN:2198-6576
2198-6584
DOI:10.1007/s40744-019-00192-5