POS0461 Characterization of patients with rheumatoid arthritis based on distinct patterns of pain improvement following treatment with filgotinib: A post hoc analysis of FINCH 1

Background: Janus kinase inhibitors have been shown to ameliorate pain as well as inflammation in patients with rheumatoid arthritis (RA) [1, 2]. A greater understanding of pain evolution and its influencing factors would help to identify opportunities to further improve disease management and patient outcomes. Objectives: To identify distinct pain response trajectories over 12 months in patients treated with filgotinib in the FINCH 1 trial. Methods: FINCH 1 (NCT02889796) was a 52-week randomized controlled trial, in which patients with RA and an inadequate response to methotrexate received filgotinib 200 mg or 100 mg, adalimumab or placebo, each with methotrexate. Patients reported pain on a visual analog scale (VAS), with responses ranging from 0 mm (no pain) to 100 mm (worst possible pain). Moderate pain was defined as a VAS pain score of 40–60 mm, with scores >60 mm indicating severe pain. A group-based trajectory modeling approach [3] was applied to identify groups of patients with similar pain response trajectories over a 12-month period. Results: A total of 955 patients were included in the analysis. Among those receiving filgotinib 200 mg (n=475), modeling produced five distinct groups of pain response trajectory (Figure 1). Groups A and B (45% of patients) had a rapid reduction in pain in the first 3 months, with the improvements maintained over 12 months. Patients in Group A showed the greatest reduction in pain. Groups C and D (35% of patients) had a slower response but achieved a reduction in pain of approximately 50% after 6 months. Group E (20% of patients) had severe pain at baseline (median VAS pain score of approximately 75 mm) and persistent, moderate pain over 12 months. Median VAS pain score was <40 mm at Month 3 in Groups A, B and C (approximately 60% of patients overall) and at Month 6 in Groups A, B, C and D (80% of all patients). Median age, disease duration and erosion score were similar across all groups at baseline. Compared with patients in Groups A, B, C and D, patients in Group E (those with persistent, moderate pain) had the highest median VAS pain score at baseline, highest median (interquartile range [IQR]) Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP) (6.33 [5.64, 6.77]), highest median (IQR) tender joint count based on 28 joints (17 [13, 21]), lowest (worst) median (IQR) Functional Assessment of Chronic Illness Therapy–Fatigue score (23 [15, 30]) and lowest (worst) median (IQR) 36-Item Short Form Survey (SF-36) Physical Component Summary (PCS) score (30 [27, 34]). At Months 3, 6 and 12, the greatest absolute changes in DAS28-CRP and SF-36 PCS score were seen in patients with the most rapid pain responses (Groups A and B) (Table 1). At Month 6, 53% of patients in Group B and 50% of patients in Group A were in remission (using Clinical Disease Activity Index), compared with 3% of patients in Group E. At Months 6 and 12, the greatest improvements from baseline in patient's and physician's global assessment of disease activity were seen in patients with the greatest and most rapid improvement in pain (Group A). Lack of efficacy was the most commonly reported reason for discontinuation in Group E (10.5%); 2.1% discontinued due to adverse events. In Groups A, B, C and D, the leading reason for discontinuation was adverse events (6.1%, 4.4%, 7.0% and 8.5%, respectively), followed by lack of efficacy (5.1%, 2.7%, 5.8% and 7.3%, respectively). Similar pain trajectory results were observed in patients receiving filgotinib 100 mg (n=480). Conclusion: Of patients with prior inadequate response to methotrexate treated with filgotinib 200 mg, 80% achieved a substantial reduction in pain within 6 months. Rapid improvements, maximal by about 3 months, were achieved in 45% of patients, and slower improvements, maximal by about 6 months, were seen in a further 35% of patients. The most rapid pain responses with filgotinib were associated with the greatest improvements in other disease-related measures. Overall, these data illustrate the heterogeneity of treatment response in patients with RA and underscore the importance of communicating realistic expectations and timelines to patients. REFERENCES: [1] Taylor PC. Lancet Rheumatol 2023;5:e351–60; [2] Mehta P, Taylor PC. Mediterr J Rheumatol 2020;31:112–9; [3] Nagin DS, et al. Stat Methods Med Res 2018;27:2015–23. Figure 1 Table 1 . Acknowledgements: We thank the physicians and patients who participated in this study. The FINCH studies were co-funded by Gilead Sciences, Inc. (Foster City, CA, USA) and Galapagos NV (Mechelen, Belgium). This analysis was funded by Alfasigma S.p.A. (Bologna, Italy). Medical writing support was provided by Debbie Sherwood, BSc, CMPP (Aspire Scientific, Bollington, UK), and funded by Alfasigma S.p.A. Publication coordination was provided by Steve Winter, PhD, and funded by Alfasigma S.p.A. The authors acknowledge the contributions of Kristina Harris and Thomas P.A. Debray to the study. Disclosure of Interests: Peter C. Taylor Consultant: AbbVie, Acelyrin Inc., Alfasigma S.p.A., Biogen, Fresenius Kabi, Gilead, Immunovant, Lilly, Moonlake, Nordic Pharma, Pfizer, Roche, Sanofi, Takeda and UCB, Grant/research support: Alfasigma S.p.A., Yoshiya Tanaka Speaker's bureau: AbbVie, Asahi Kasei, Astellas, AstraZeneca, Boehringer Ingelheim, Chugai, Daiichi Sankyo, Eisai, Gilead, GSK, Lilly, Pfizer, Taisho and UCB, Grant/research support: Boehringer Ingelheim, Chugai and Taisho, Louis Dron: None declared, Katrien Van Beneden Employee: Alfasigma S.p.A., Gerd R. Burmester Speaker's bureau: AbbVie, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, Sanofi and UCB, Consultant: AbbVie, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, Sanofi and UCB, Bruno Fautrel Consultant: AbbVie, Amgen, Biogen, BMS, Celltrion, Chugai, Fresenius Kabi, Galapagos, Janssen, Lilly, Medac, MSD, Nordic Pharma, Novartis, Owkin, Pfizer, Roche, Sandoz, Sanofi-Genzyme, Sobi, UCB and Viatris, Grant/research support: AbbVie, Lilly, Pfizer and Sanofi-Aventis. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.