Filgotinib

How it works

It preferentially inhibits JAK1, blocking signalling of pro-inflammatory cytokines through the JAK-STAT pathway and thereby reducing the immune-mediated mucosal inflammation of ulcerative colitis.

Prescribing in practice

• As a JAK inhibitor it carries MHRA-highlighted risks of serious infection, venous thromboembolism, major adverse cardiovascular events and malignancy, so use cautiously and reserve higher-risk patients for when no suitable alternatives exist.
• Screen for and treat latent tuberculosis and viral hepatitis before starting, and ensure vaccinations including herpes zoster are up to date as live vaccines are contraindicated during treatment.
• Avoid in pregnancy; effective contraception is required during treatment because of potential effects on fertility and the developing fetus.

Monitoring

Monitor full blood count, lipids and liver function, and remain vigilant for signs of infection, thromboembolism and skin malignancy throughout treatment.

Counselling the patient

• Report any signs of infection such as fever, cough or persistent sore throat, and any leg swelling, chest pain or breathlessness promptly.
• Do not have live vaccines while taking this medicine and tell the team you are on it before any vaccination.

Evidence & guidelines

Filgotinib is recommended by NICE within its marketing authorisation for moderately to severely active ulcerative colitis.