, Silvio Danese2,3
, Yoshie Takatori4
, Toshihiko Kaise4
, Christine Rudolph5
, Marc Ferrante6
, Toshifumi Hibi7
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
2Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy
3Vita-Salute San Raffaele University, Milan, Italy
4Gilead Sciences K.K., Tokyo, Japan
5Alfasigma S.p.A., Munich, Germany
6Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
7Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
© 2025 Korean Association for the Study of Intestinal Diseases.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Funding Source
The SELECTION trial was sponsored by Gilead Sciences, Inc. (Foster City, California, USA). Galapagos NV (Mechelen, Belgium) collaborated in the SELECTION study. This post hoc analysis was funded by Gilead Sciences K.K. (Tokyo, Japan), Eisai Co., Ltd. (Tokyo, Japan), and EA Pharma Co., Ltd. (Tokyo, Japan).
Conflict of Interest
Saruta M has received scholarship grants from AbbVie GK, CMIC CMO Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., PPD-SNBL K.K., and Zeria Pharmaceutical Co., Ltd., and lecture fees from AbbVie GK, EA Pharma Co., Ltd., Gilead Sciences K.K., Janssen Pharmaceutical K.K., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd, Nobelpharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Viatris Pharmaceutical Co., Ltd. outside the submitted work. Danese S reports consultancy fees from AbbVie, Alimentiv, Allergan, Amgen, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera Pharmaceuticals, Ferring Pharmaceuticals, Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, TiGenix, UCB, and Vifor; and lecture fees from AbbVie, Amgen, Ferring Pharmaceuticals, Gilead, Janssen, Mylan, Pfizer, and Takeda. Takatori Y and Kaise T are employees of Gilead Sciences K.K. and are shareholders of Gilead Sciences, Inc. Rudolph R is an employee of Alfasigma S.p.A. Ferrante M has received financial support for research from AbbVie, Biogen, EG Pharmaceuticals, Janssen Pharmaceuticals, Pfizer, Takeda, and Viatris; speaker fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring Pharmaceuticals, Janssen-Cilag, MSD, Pfizer, Takeda, Truvion Healthcare, and Viatris; and is a consultant for AbbVie, Agomab Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, MRM Health, MSD, Pfizer, Takeda, and Thermo Fisher Scientific. Hibi T has received lecture fees from AbbVie GK, EA Pharma Co., Ltd., Janssen Pharmaceutical K.K., JIMRO Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sandoz K.K., Takeda Pharmaceutical Co., Ltd., and Zeria Pharmaceutical Co., Ltd.; advisory/consultancy fees from AbbVie GK, Celltrion Healthcare Japan K.K., EA Pharma Co., Ltd., Eli Lilly Japan K.K., Gilead Sciences K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Nichi-Iko Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Zeria Pharmaceutical Co., Ltd.; and research grants from AbbVie GK, Activaid, Alfresa Pharma Corporation, Bristol Myers Squibb K.K., Eli Lilly Japan K.K., Ferring Pharmaceuticals Co., Ltd., Gilead Sciences K.K., Janssen Pharmaceutical K.K., JIMRO Co., Ltd., JMDC Inc., Kyorin Pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Pfizer Japan Inc., and Zeria Pharmaceutical Co., Ltd. Hibi T is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article.
Data Availability Statement
Gilead Sciences shares anonymized individual patient data upon request or as required by law or regulation with qualified external researchers based on submitted curricula vitae and reflecting non conflict of interest. The request proposal must also include a statistician. Approval of such requests is at Gilead Sciences’ discretion and is dependent on the nature of the request, the merit of the research proposed, the availability of the data, and the intended use of the data. Data requests should be sent to datarequest@gilead.com.
Author Contributions
Conceptualization: Takatori Y, Kaise T. Formal analysis: Saruta M. Investigation: Saruta M, Danese S, Ferrante M, Hibi T. Methodology: Takatori Y, Kaise T, Rudolph C. Project administration: Saruta M, Takatori Y. Writing - review & editing: all authors. Approval of final manuscript: all authors.
Additional Contributions
The authors thank Ruby Oberin PhD and Tamsyn Stanborough PhD of Oxford PharmaGenesis, Melbourne, Australia, for providing medical writing support, which has been funded by Gilead Sciences K.K., Tokyo, Japan, Eisai Co., Ltd., Tokyo, Japan, and EA Pharma Co., Ltd., Tokyo, Japan, in accordance with Good Publication Practice 2022 (GPP 2022) guidelines (https://www.ismpp.org/gpp-2022).
| Outcome | Definition |
|---|---|
| Clinical remission | An MES of 0 or 1, a Mayo rectal bleeding subscore of 0, and a decrease in Mayo stool frequency subscore of ≥ 1 point from induction baseline for a subscore of 0 or 1 |
| MCS responsea | A decrease in MCS of ≥ 3 points and a ≥ 30% decrease from baseline, with a decrease in rectal bleeding subscore of ≥ 1 point, or an absolute rectal bleeding subscore of 0 or 1 |
| Symptomatic remission | A Mayo rectal bleeding subscore of 0 and a stool frequency subscore of ≤ 1 |
| MCS remissiona | An MCS of ≤ 2 and no single subscore of > 1 |
| Endoscopic remission | An MES of 0 |
| Endoscopic response | An MES of 0 or 1 |
| Histological remission | Based on the Geboes Scale; remission required no or a mild increase in chronic inflammatory infiltrate in the lamina propria, no neutrophils in the lamina propria or epithelium, and no erosion, ulceration, or granulation tissue (grade 0 of ≤ 0.3, grade 1 of ≤ 1.1, grade 2a of ≤ 2A.3, grade 2b of 2B.0, grade 3 of 3.0, grade 4 of 4.0, and grade 5 of 5.0) |
| IBDQ remission | An IBDQ total score of ≥ 170 |
Values are presented as mean±SD, number (%), or median (IQR).
pMCS, partial Mayo Clinic Score; FIL200, filgotinib 200 mg; PBO, placebo; BMI, body mass index; UC, ulcerative colitis; MCS, Mayo Clinic Score; MES, Mayo endoscopic subscore; CRP, C-reactive protein; 5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor; SD, standard deviation; IQR, interquartile range.
| Outcome | Definition |
|---|---|
| Clinical remission | An MES of 0 or 1, a Mayo rectal bleeding subscore of 0, and a decrease in Mayo stool frequency subscore of ≥ 1 point from induction baseline for a subscore of 0 or 1 |
| MCS response |
A decrease in MCS of ≥ 3 points and a ≥ 30% decrease from baseline, with a decrease in rectal bleeding subscore of ≥ 1 point, or an absolute rectal bleeding subscore of 0 or 1 |
| Symptomatic remission | A Mayo rectal bleeding subscore of 0 and a stool frequency subscore of ≤ 1 |
| MCS remission |
An MCS of ≤ 2 and no single subscore of > 1 |
| Endoscopic remission | An MES of 0 |
| Endoscopic response | An MES of 0 or 1 |
| Histological remission | Based on the Geboes Scale; remission required no or a mild increase in chronic inflammatory infiltrate in the lamina propria, no neutrophils in the lamina propria or epithelium, and no erosion, ulceration, or granulation tissue (grade 0 of ≤ 0.3, grade 1 of ≤ 1.1, grade 2a of ≤ 2A.3, grade 2b of 2B.0, grade 3 of 3.0, grade 4 of 4.0, and grade 5 of 5.0) |
| IBDQ remission | An IBDQ total score of ≥ 170 |
| Characteristic | Induction study A (biologic-naive) |
Induction study B (biologic-experienced) |
||||||
|---|---|---|---|---|---|---|---|---|
| FIL200 |
PBO |
FIL200 |
PBO |
|||||
| pMCS ≥7 (n=90) | pMCS <7 (n=155) | pMCS ≥7 (n=49) | pMCS <7 (n=88) | pMCS ≥7 (n=148) | pMCS <7 (n=114) | pMCS ≥7 (n=71) | pMCS <7 (n=71) | |
| Age (yr) | 41.9 ± 12.2 | 42.5 ± 13.6 | 42.0 ± 12.4 | 40.9 ± 13.2 | 43.9 ± 14.5 | 42.4 ± 13.7 | 43.5 ± 15.2 | 45.4 ± 14.7 |
| Female sex | 56 (62.2) | 66 (42.6) | 15 (30.6) | 35 (39.8) | 61 (41.2) | 53 (46.5) | 29 (40.8) | 27 (38.0) |
| Body weight (kg) | 66.0 (59.9–81.4) | 66.2 (55.9–80.3) | 71.1 (60.0–81.2) | 63.0 (56.7–79.7) | 72.2 (62.0–87.1) | 68.1 (55.3–80.0) | 72.0 (61.2–84.3) | 70.0 (58.7–85.0) |
| BMI (kg/m2) | 24.2 (21.0–27.5) | 23.9 (20.4–28.0) | 24.1 (20.8–26.9) | 22.9 (20.7–26.9) | 24.4 (21.7–28.8) | 24.0 (20.8–27.4) | 24.3 (21.5–28.0) | 23.7 (20.6–27.8) |
| Smoking status | ||||||||
| Current | 7 (7.8) | 8 (5.2) | 3 (6.1) | 2 (2.3) | 6 (4.1) | 2 (1.8) | 3 (4.2) | 2 (2.8) |
| Former | 21 (23.3) | 34 (21.9) | 9 (18.4) | 13 (14.8) | 39 (26.4) | 34 (29.8) | 22 (31.0) | 21 (29.6) |
| Never | 62 (68.9) | 113 (72.9) | 37 (75.5) | 73 (83.0) | 103 (69.6) | 78 (68.4) | 46 (64.8) | 48 (67.6) |
| Duration of UC (yr) | 7.7 ± 7.2 | 6.9 ± 6.7 | 5.7 ± 6.7 | 6.8 ± 7.8 | 10.0 ± 7.6 | 9.6 ± 7.8 | 9.7 ± 8.4 | 10.6 ± 8.0 |
| Total MCS | 9.7 ± 0.9 | 8.0 ± 1.1 | 9.8 ± 1.1 | 8.0 ± 0.9 | 10.0 ± 1.0 | 8.2 ± 1.2 | 10.2 ± 1.2 | 8.4 ± 1.1 |
| MES of 3 | 56 (62.2) | 77 (49.7) | 33 (67.3) | 43 (48.9) | 124 (83.8) | 79 (69.3) | 61 (85.9) | 50 (70.4) |
| CRP (mg/L) | 11.0 ± 22.9 | 7.2 ± 10.6 | 7.2 ± 8.0 | 5.0 ± 7.3 | 15.0 ± 16.4 | 8.5 ± 11.7 | 19.2 ± 32.1 | 8.7 ± 10.2 |
| Fecal calprotectin (µg/g) | 2,341 ± 2,751 | 1,889 ± 2,564 | 2,499 ± 3,125 | 2,079 ± 2,799 | 3,197 ± 4,105 | 2,376 ± 4,009 | 2,889 ± 4,416 | 2,063 ± 2,397 |
| Prednisone-equivalent dose (mg/day) | 20.0 (10.0–23.8) | 20.0 (10.0–30.0) | 20.0 (17.5–27.5) | 20.0 (12.5–30.0) | 20.0 (10.0–20.0) | 15.0 (10.0–20.0) | 20.0 (15.0–25.0) | 10.0 (5.0–20.0) |
| No. of prior biologic agents used | ||||||||
| 0 | 90 (100.0) | 155 (100.0) | 49 (100.0) | 88 (100.0) | 3 (2.0) | 0 | 0 | 3 (4.2) |
| 1 | 0 | 0 | 0 | 0 | 30 (20.3) | 50 (43.9) | 24 (33.8) | 22 (31.0) |
| 2 | 0 | 0 | 0 | 0 | 63 (42.6) | 27 (23.7) | 25 (35.2) | 20 (28.2) |
| ≥3 | 0 | 0 | 0 | 0 | 52 (35.1) | 37 (32.5) | 22 (31.0) | 26 (36.6) |
| Concomitant use of | ||||||||
| Systemic corticosteroids | 25 (27.8) | 29 (18.7) | 15 (30.6) | 19 (21.6) | 53 (35.8) | 41 (36.0) | 26 (36.6) | 25 (35.2) |
| Immunomodulators only | 9 (10.0) | 44 (28.4) | 9 (18.4) | 24 (27.3) | 13 (8.8) | 21 (18.4) | 10 (14.1) | 11 (15.5) |
| Systemic corticosteroids and immunomodulators | 9 (10.0) | 11 (7.1) | 4 (8.2) | 4 (4.5) | 17 (11.5) | 11 (9.6) | 7 (9.9) | 4 (5.6) |
| 5-ASA | 80 (88.9) | 139 (89.7) | 41 (83.7) | 77 (87.5) | 79 (53.4) | 74 (64.9) | 42 (59.2) | 41 (57.7) |
| Previously received treatments | ||||||||
| ≥ 1 TNF antagonist | - | - | - | - | 140 (94.6) | 102 (89.5) | 67 (94.4) | 63 (88.7) |
| Vedolizumab | - | - | - | - | 104 (70.3) | 60 (52.6) | 42 (59.2) | 43 (60.6) |
| ≥ 1 TNF antagonist and vedolizumab | - | - | - | - | 99 (66.9) | 48 (42.1) | 38 (53.5) | 38 (53.5) |
| Previously failed treatments | ||||||||
| ≥ 1 TNF antagonist | - | - | - | - | 127 (85.8) | 91 (79.8) | 64 (90.1) | 56 (78.9) |
| Vedolizumab | - | - | - | - | 92 (62.2) | 56 (49.1) | 40 (56.3) | 36 (50.7) |
The MCS is composed of 4 subscores (stool frequency, rectal bleeding, endoscopic findings, and the Physician’s Global Assessment) ranging from 0 to12. MES, Mayo endoscopic subscore; MCS, Mayo Clinic Score; IBDQ, Inflammatory Bowel Disease Questionnaire.
Values are presented as mean±SD, number (%), or median (IQR). pMCS, partial Mayo Clinic Score; FIL200, filgotinib 200 mg; PBO, placebo; BMI, body mass index; UC, ulcerative colitis; MCS, Mayo Clinic Score; MES, Mayo endoscopic subscore; CRP, C-reactive protein; 5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor; SD, standard deviation; IQR, interquartile range.
