BackgroundFIL is a Janus kinase (JAK) 1 preferential inhibitor approved for the treatment (tx) of moderate to severe RA. Weight gain has been reported with other JAK inhibitors1–3; it is important to describe the effect of FIL on BW/BMI for physicians to correctly inform and appropriately treat patients.ObjectivesOur primary aim was to assess the effect of FIL on BW/BMI using data from the FINCH 1–3 studies. Secondary aims were to assess the efficacy and safety of FIL according to baseline BMI.MethodsFINCH 1–3 (NCT02889796, NCT02873936, NCT02886728) were phase 3, randomised, double-blind, active/placebo (PBO)-controlled studies of FIL 100/200 mg (FIL100/FIL200) ± methotrexate (MTX) in patients with active RA who had an inadequate response to MTX (FINCH 1) or biologic DMARD (FINCH 2), or were MTX naïve (FINCH 3). We assessed changes from baseline (CFB) in BW and BMI by tx group and baseline BMI, and the efficacy and safety of FIL by baseline BMI (2). Efficacy measures included American College of Rheumatology (ACR)20/50/70 response, Disease Activity Score 28 with C-reactive protein (DAS28-CRP) and health assessment questionnaire disability index (HAQ-DI). Safety data were from 7 RA clinical trials (FINCH 1–4, DARWIN 1–3)4.ResultsIn FINCH 1–3, baseline disease characteristics such as HAQ-DI, DAS28-CRP and clinical disease activity index were similar across BMI subgroups for each tx group. There were no clinically relevant CFB in median BW or BMI in any tx group or differences between tx groups. Mean CFB in BMI (kg/m2) were 0.4 with FIL200 and FIL100 and 0.3 with adalimumab (ADA) at Week 52 in FINCH 1; 0.2, 0.6 and −0.1 with FIL200, FIL100 and PBO, respectively, at Week 24 in FINCH 2; and 0.5, 0.6, 1.1 and 0.3 with FIL200+MTX, FIL100+MTX, FIL200 and MTX, respectively, at Week 52 in FINCH 3.CFB in BMI did not appear dependent on baseline BMI. FIL200±MTX was efficacious vs controls regardless of baseline BMI for most measures at each timepoint. In FINCH 1, in the 2 BMI subgroups, DAS28-CRP 2 BMI subgroups; serious infection rate was numerically higher with FIL100 in the 2 subgroup vs other BMI subgroups.Table 1.Exposure-adjusted incidence rate (95% CI) of AEs per 100 PYE by baseline BMIFIL dose (mg)BMI (kg/m2)25–≥30PYE 3062.8PYE 2640.1PYE 2382.2TEAEs20034.5 (32.0, 37.1)35.7 (33.0, 38.6)36.6 (33.7, 39.8)10044.3 (40.4, 48.6)43.0 (38.9, 47.5)45.3 (41.1, 50.0)Serious TEAEs2005.3 (4.4, 6.4)5.8 (4.8, 7.1)7.1 (5.8, 8.5)1007.6 (6.0, 9.4)6.5 (5.0, 8.4)8.1 (6.4, 10.2)Deaths2000.3 (0.2, 0.7)0.5 (0.3, 1.0)0.5 (0.2, 1.0)1000.4 (0.1, 1.0)0.3 (0.1, 1.0)0.2 (0.1, 0.9)Venous thrombotic and embolic events2000.1 (0.0, 0.4)0.1 (0.0, 0.5)0.5 (0.2, 1.0)1000.1 (0.0, 0.7)0.1 (0.0, 0.8)0.2 (0.1, 0.9)Major adverse cardiovascular events2000.3 (0.2, 0.7)0.3 (0.1, 0.7)0.5 (0.2, 1.0)1000.6 (0.3, 1.3)0.3 (0.1, 1.0)0.6 (0.2, 1.4)Serious infections2001.1 (0.7, 1.7)1.7 (1.2, 2.5)1.8 (1.2, 2.6)1002.6 (1.8, 3.9)1.2 (0.7, 2.2)2.2 (1.4, 3.4)Herpes zoster2001.6 (1.1, 2.2)1.4 (1.0, 2.1)1.8 (1.2, 2.6)1001.0 (0.5, 1.8)1.2 (0.7, 2.2)1.0 (0.5, 2.0)Malignancy excluding nonmelanoma skin cancer2000.5 (0.3, 1.0)0.7 (0.4, 1.3)0.5 (0.3, 1.1)1000.6 (0.3, 1.3)0.4 (0.2, 1.2)0.8 (0.4, 1.7)BMI, body mass index; FIL, filgotinib; PYE, patient years of exposure; (TE)AE, (treatment-emergent) adverse eventConclusionFIL did not substantially affect CFB in BW or BMI. FIL200±MTX was generally more efficacious vs controls regardless of baseline BMI, and the rate of TEAEs was similar across baseline BMI subgroups.References[1]Tofacitinib SmPC[2]Baracitinib SmPC[3]Upadacitinib SmPC[4]Winthrop K, et al. ACR 2021. Abstract 1698AcknowledgementsThe FINCH studies were funded by Gilead Sciences (Foster City, CA, United States).We thank the physicians and patients who participated in the studies.Medical writing support was provided by Debbie Sherwood, BSc (Aspire Scientific Ltd, Bollington, UK) and funded by Galapagos NV (Mechelen, Belgium).Disclosure of InterestsAlejandro Balsa Speakers bureau: AbbVie, Galapagos, Gilead, Lilly, Nordic, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Galapagos, Lilly, Nordic, Pfizer, and UCB, Grant/research support from: AbbVie, Pfizer, UCB, Siegfried Wassenberg Speakers bureau: AbbVie, MSD, Pfizer, and Sanofi, Consultant of: AbbVie, Gilead, Lilly, Nichi-Iko, Pfizer, and UCB, Grant/research support from: Pfizer, Anne Tournadre Speakers bureau: Fresenius-Kabi and Sanofi, Paid instructor for: Fresenius-Kabi, Consultant of: AbbVie, Fresenius-Kabi, Lilly, Novartis, and Sanofi, Grant/research support from: Novartis, Pfizer, and UCB, Hans-Dieter Orzechowski Employee of: Galapagos, Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, Vijay Rajendran Employee of: Galapagos, Udo Lendl Employee of: Galapagos, Pieter-Jan Stiers Shareholder of: Galapagos, Employee of: Galapagos, Chris Watson Shareholder of: Galapagos, Employee of: Galapagos, Roberto Caporali Speakers bureau: AbbVie, Accord, BMS, Celltrion, Fresenius-Kabi, Galapagos, Lilly, MSD, Novartis, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Accord, BMS, Celltrion, Fresenius-Kabi, Galapagos, Lilly, MSD, Novartis, Pfizer, Sandoz, and UCB, Patrick Verschueren Speakers bureau: Eli Lilly, Galapagos, MSD, and Roularta, Consultant of: AbbVie, BMS, Celltrion, Eli Lilly, Galapagos, Gilead, Nordic Pharma, Pfizer, Sidekick Health, and UCB, Grant/research support from: Pfizer Chair Management of Early Rheumatoid Arthritis at KU Leuven Belgium.