类风湿性关节炎 (RA) 中的高基线中性粒细胞与淋巴细胞比率 (NLR) 与生物肿瘤坏死因子抑制的阳性反应和传统合成缓解病情抗风湿药物 (csDMARD) 三联疗法的阴性反应相关。使用来自 RA 患者的三项随机临床试验的数据集来检验以下假设：基线 NLR 与未接受过甲氨蝶呤 (MTX) 或经历过 MTX 的 RA 人群中对 filgotinib 的临床反应改善相关。来自 FINCH 1 的患者（对 MTX 反应不足） 、MTX-IR；NCT02889796)、FINCH 2（对生物 DMARD 反应不足；NCT02873936）和 FINCH 3（MTX 未使用；NCT02886728）根据之前发布的临界点被分类为基线 NLR-高或基线 NLR-低2.7.三项研究总共纳入了 3365 名患者。使用线性回归模型确定临床结果和患者报告结果 (PRO) 的差异。与临床试验相比，被分类为 NLR-高的对照组患者（安慰剂  MTX/安慰剂  csDMARD）在第 12 周表现出更差的连续临床和 PRO 反应NLR 低的患者。相比之下，在临床试验、临床终点和 PRO 中，与 NLR 低患者相比，接受 FIL 200 mg  MTX/csDMARD 的 NLR 高患者在 12 周后表现出一致更好的反应。这些趋势在 MTX-IR 人群中最为突出。2.7 基线 NLR 切点可用于丰富最有可能从在背景 MTX/csDMARD 中添加 filgotinib 中受益的患者。使用基线 NLR 作为治疗决策的一部分不需要额外的诊断，并且可能有助于改善 RA 患者的预后。Clinicaltrials.gov：NCT02889796； NCT02873936； NCT02886728.© 2024。作者。

High baseline neutrophil-to-lymphocyte ratio (NLR) in rheumatoid arthritis (RA) has been associated with positive responses to biologic tumor necrosis factor inhibition and negative responses to conventional synthetic disease-modifying antirheumatic drug (csDMARD) triple therapy. Datasets from three randomized clinical trials in patients with RA were used to test the hypothesis that baseline NLR is associated with improved clinical response to filgotinib in methotrexate (MTX)-naïve or MTX-experienced RA populations.Patients from FINCH 1 (inadequate response to MTX, MTX-IR; NCT02889796), FINCH 2 (inadequate response to biologic DMARDs; NCT02873936), and FINCH 3 (MTX-naïve; NCT02886728) were classified as baseline NLR-High or baseline NLR-Low based on a previously published cut point of 2.7. In total, 3365 patients were included across the three studies. Differences in clinical outcomes and patient-reported outcomes (PROs) were determined using linear-regression models.Control-arm patients (placebo + MTX/placebo + csDMARD) classified as NLR-High exhibited worse continuous clinical and PRO responses at week 12 across clinical trials compared to NLR-Low patients. In contrast, NLR-High patients who received FIL 200 mg + MTX/csDMARD exhibited consistently better responses after 12 weeks compared to NLR-Low patients across clinical trials, clinical endpoints, and PROs. These trends were most prominent among the MTX-IR population.The 2.7 baseline NLR cut point could be used to enrich for patients most likely to benefit from the addition of filgotinib to background MTX/csDMARD. Use of baseline NLR as part of therapeutic decision-making would not require additional diagnostics and could contribute to improved outcomes for patients with RA.Clinicaltrials.gov: NCT02889796; NCT02873936; NCT02886728.© 2024. The Author(s).