Deutscher Rheumatologiekongress 2026
Early and rapid pain relief with filgotinib in routine care: Interim results from the FIRST-RA study
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Introduction: Filgotinib is an oral, JAK1-preferential inhibitor approved for moderate-to-severe rheumatoid arthritis (RA). While efficacy is established in randomized trials, very early real-world changes in pain and other patient-reported outcomes (PROs) need additional attention. We aim to describe baseline characteristics and prior RA therapies of patients initiating filgotinib in FIRST-RA and to assess very early changes in pain and other Rheumatoid Arthritis Impact of Disease (RAID) domains over the first 4 weeks.
Methods: FIRST-RA (DRKS00036136) is an ongoing, prospective, multicenter, non-interventional cohort study in Germany and Austria enrolling adults with active RA starting filgotinib per label. Clinical data are collected at baseline and Weeks 4, 12, and 24. PROs (RAID, including pain and fatigue) are recorded at baseline (Day 0), daily on Days 1-7, and weekly up to Week 4. This descriptive interim analysis uses a data cut of February 23, 2026 (n=126). Patients were grouped by prior advanced therapy (AT; bDMARD/tsDMARD): 0, 1, or ≥2.
Results: Mean (SD) age was 54.7 (13.3) years; 76.2% were female; mean BMI was 27.9 (5.4) kg/m²; mean RA duration 8.6 (9.0) years; baseline DAS28-CRP 4.0 (1.1). Prior therapies were common (methotrexate 88.8%, leflunomide 44.8%); 54.4% had received a TNF inhibitor (Figure 1 [Fig. 1]). Prior AT exposure: 43.0% none, 36.4% one, 20.7% ≥2. Filgotinib was most often used as monotherapy; one quarter (24.5%) received combination with a csDMARD. Mean (SD) RAID pain score was 5.9 (2.1) at baseline; mean change was −0.7 (1.2) at Day 3, −1.7 (1.7) at Day 7, and −2.8 (2.4) at Week 4 (Figure 2 [Fig. 2]). Pain responders (≥ 1-point decrease) increased from 50.5% (Day 3) to 78.3% (Day 7) and 85.9% (Week 4). Similar improvements were observed for RAID fatigue and total score.
Figure 1: Therapy immediately prior to filgotinib initiation and at start of study documentation
Figure 2: Mean change in RAID pain score (0-10) over 28 days after filgotinib initiation; numbers above the x-axis indicate the sample size at each time point
Conclusion: In routine care, patients initiating filgotinib showed rapid, clinically meaningful pain relief within the first week, with continued improvement through Week 4, mirrored by reductions in fatigue and overall RAID scores.
Acknowledgements: We thank the physicians and patients who participated in the study. The FIRST-RA study was sponsored by Alfasigma GmbH (Munich, Germany).
Disclosure of interest: Georg Pongratz Paid instructor: Eli Lilly, Speakers bureau: AbbVie, Alfasigma, Boehringer Ingelheim, Eli Lilly & Co., Galapagos, Pfizer, Roche, Sanofi, Viatris and Vertanical, Consultant: AbbVie, Alfasigma, Boehringer Ingelheim, Eli Lilly & Co., Galapagos, Pfizer, Roche, Sanofi, Viatris and Vertanical.
Rieke Alten Speakers bureau: AbbVie, Alfasigma, Amgen, Biogen, BMS, Celltrion, Chugai, Eli Lilly & Co., Galapagos, Gilead, Hexal, Janssen, Novartis, Pfizer, Roche, UCB and Viatris, Consultant: AbbVie, Alfasigma, Amgen, Biogen, BMS, Celltrion, Chugai, Eli Lilly & Co., Galapagos, Gilead, Hexal, Janssen, Novartis, Pfizer, Roche, UCB and Viatris
Torsten Witte Speakers bureau: AbbVie, Alfasigma, Eli Lilly & Co. and Pfizer, Consultant: AbbVie, Alfasigma, Eli Lilly & Co. and Pfizer.
Christine Pausch: None declared.
Robert Reinhold Employee: Alfasigma GmbH.
David Pittrow Consultant: Alfasigma, Amgen, Aspen, Bayer, Boehringer Ingelheim, MSD, Sandoz/Hexal and Viatris.
Gerd R. Burmester Speakers bureau: AbbVie, Alfasigma, BMS, Eli Lilly & Co., Galapagos, Janssen, Novartis, Pfizer, Sanofi and UCB, Consultant: AbbVie, Alfasigma, BMS, Eli Lilly & Co., Galapagos, Janssen, Novartis, Pfizer, Sanofi and UCB
