Efficacy and Safety of Selective JAK 1 Inhibitor Filgotinib in Active Rheumatoid Arthritis Patients With Inadequate Response to Methotrexate

  • End date
    Dec 31, 2023
  • participants needed
  • sponsor
    Atsushi Kawakami
Updated on 10 November 2021


The administration of Janus kinase (JAK) inhibitors as well as biological disease-modifying anti-rheumatic drugs has dramatically improved even the clinical outcomes in rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX). The dysregulation of JAK-signal transducer and activator of transcription (STAT) pathways via overproduction of cytokines, such as interleukin-6 (IL-6) is involved in the pathogenesis of RA. Filgotinib is a selective JAK1 inhibitor to be approved for use in RA. Filgotinib is effective in suppressing disease activity and preventing the progression of joint destruction due to inhibition of the JAK-STAT pathway. IL-6 inhibitors such as tocilizumab also inhibit the JAK-STAT pathways due to inhibition of IL-6 signaling. We will evaluate whether the effectiveness and safety of filgotinib monotherapy is non-inferior to those of tocilizumab monotherapy in RA patients with inadequate response to MTX.

Condition Rheumatoid Arthritis (Pediatric), IL-6 Inhibitor, Musculoskeletal Ultrasound, Rheumatoid Arthritis, Biological Markers, JAK Inhibitor
Treatment filgotinib 200mg/day, subcutaneous tocilizumab 162mg/biweekly
Clinical Study IdentifierNCT05090410
SponsorAtsushi Kawakami
Last Modified on10 November 2021


Yes No Not Sure

Inclusion Criteria

Patients must meet all of the following requirements to be considered for entry into the study
20 years old
with the diagnosis of RA based on the ACR/EULAR 2010 RA Classification Criteria
with at least moderate disease activity defined as a DAS28-ESR 3.2 at the eligibility evaluation
treated with MTX for 8 weeks prior to the providing consent, including 4 weeks or more at the same doses of 8 to 16 mg per week (stable doses of <8 mg per week are allowed only in the presence of intolerance to higher doses)
ability and willingness to provide written informed consent and comply with the requirements of the study protocol

Exclusion Criteria

The exclusion criteria are as follows
concurrent use of a corticosteroid equivalent to >5 mg/day of prednisolone
applicable an item for the contraindication of filgotinib or tocilizumab
a previous use of a JAK inhibitor or IL-6 inhibitor
treatment with a corticosteroid and csDMARD and change of dose within 4 weeks prior to the providing consent
treatment with a biologic DMARD or a biosimilar DMARD (ie, infliximab, biosimilar of infliximab, adalimumab, biosimilar of adalimumab, golimumab, certolizumab pegol or abatacept) within 8 weeks prior to the providing consent
treatment with a TNF inhibitor (ie, etanercept or biosimilar of etanercept) within 4 weeks prior to the providing consent
use of a prohibited drug or therapy, other than the agents noted above, within 4 weeks prior to the providing consent
a complication causing musculoskeletal disorders other than RA (ie, ankylosing spondyloarthritis, reactive arthritis, psoriatic arthritis, crystal-induced arthritis, systemic lupus erythematosus, systemic scleroderma, inflammatory myopathy, or mixed connective tissue disease)
current pregnancy, breastfeeding, or noncompliant with a medically approved contraceptive regimen during and 12 months after the study period
inappropriateness for inclusion in this study as determined by the investigator
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