What is Golimumab?
Golimumab (also known by its trade name Simponi) is a medication given for the treatment of rheumatoid arthritis. It is also used to treat psoriatic arthritis and ankylosing spondylitis.
How does it work?
Golimumab works by binding to a substance called tumour necrosis factor (TNF). It is one of a number of anti-TNF drugs used to treat rheumatoid arthritis. TNF is a key element in the development of inflammation. In rheumatoid arthritis, there is over-production of TNF, leading to excess inflammation affecting the joints which causes pain, swelling and ultimately joint destruction. By binding to TNF, golimumab prevents it from promoting inflammation. This leads to a reduction in symptoms and prevention of further joint damage.
What is it used for/when is it used?
Golimumab can be used if the arthritis is still active, and two or more DMARDs (Disease Modifying Anti-Rheumatic Drugs) such as methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, etc have not been effective in controlling the disease. Golimumab can also be used if the rheumatoid arthritis is still active, and you have previously tried other anti-TNF drugs, such as etanercept, infliximab, adalimumab, or certolizumab pegol; or are unable to tolerate rituximab.
How is it administered?
It is given as a subcutaneous (under the skin) injection once a month. Golimumab is normally used with methotrexate, but can be given on its own.
Who should not take golimumab?
Golimumab is only given to patients with active disease. This is measured by the DAS (disease activity score) which looks at symptoms, joint pain, swelling and markers of inflammation.
Golimumab should not be given if there is active infection. Your doctor may also advise you not to take golimumab if you suffer from chronic or recurrent infections, or have previously been exposed to tuberculosis.
If you or a family member suffer from multiple sclerosis (MS) your doctor may decide against prescribing golimumab (MS causes patches of inflammation in the brain or spinal cord, leading to symptoms such as visual disturbance, limb weakness and muscles spasms. The symptoms initially come and go but can eventually become permanent).
Golimumab should be avoided in patients with heart failure since it can worsen symptoms. Tell your doctor if you get new or worsening symptoms of heart failure. Symptoms of heart failure may include shortness of breath or swelling of your feet.
What are the potential side effects?
As with all medication, golimumab can cause side effects. The likelihood of these side effects are similar to those of other anti-TNF therapies currently available.
The more common side effects are headache, nausea and mild swelling and redness at the site of injection.
Golimumab lowers your body’s ability to fight infection. Thus, patients who take golimumab may be more susceptible to infections and may take longer to recover from them. Mild infections are more common, whereas severe infections such as tuberculosis are much more rare. You should seek medical help if you develop any signs of infection including:
- fever, sweats or chills
- shortness of breath
- weight loss
- diarrhoea, stomach pain or vomiting
- burning when you pass urine, or passing more urine than normal
Golimumab does not appear to increase the risk of malignancies in general or the risks of lymphoma or non-melanoma skin cancer, but the risk of melanoma may be slightly increased. This is undergoing further research.
What tests do I need before starting golimumab?
Your doctor will take an extensive past medical and drug history including information about:
- Heart failure
- Chronic infections
- Previous exposure to tuberculosis either in yourself or close family members
- Multiple Sclerosis
- Any previous or active cancer
Since golimumab can increase the risk of reactivation of certain chronic infections, your doctor will test you for tuberculosis and hepatitis B prior to starting treatment. This will include blood tests and a chest X-ray.
When should I stop Golimumab?
Stop golimumab immediately if you develop an allergic reaction i.e. rash, hives, swollen lips or a swollen tongue.
You should stop golimumab if you develop an infection. It can be re-started once the infection has cleared.
Seek medical attention immediately if you are in contact with or develop chickenpox or shingles.
Golimumab should also be witheld before and during surgery. You will need to check with your rheumatology consultant when to stop and restart the drug.
How is the treatment monitored?
Your doctor will monitor if golimumab is effective by measuring your DAS. Although it may take up to three months (around 3-4 doses) before golimumab has an effect it may be faster than this.
Your doctor will also check you blood counts and liver tests on a regular basis.
How can I avoid infection?
- Avoid food such as un-pasteurised milk, products containing raw or undercooked eggs or meat (such as mayonnaise or pate), mould-ripened cheese such as Brie or Camembert, blue cheese, goats or feta cheese.
- Avoid taking “live” vaccinations - your family doctor can advise you about this.
- Avoid contact with anyone suffering from chickenpox or shingles.
- Wash raw fruit and vegetables before consumption.
- Ensure chilled/ready prepared meals are piping hot before serving.
Your doctor may advise the Pneumovax vaccine, and you should have the flu vaccine every year.
Can I take golimumab during pregnancy?
Golimumab is not licensed for pregnant women or those that are breast-feeding.It is unknown what effect golimumab will have on your baby. You should also avoid golimumab if you are breast-feeding. However, limited studies of other anti-TNF drugs suggest that little or no drug gets into the breast milk.If you become pregnant whilst taking golimumab, contact your doctor immediately.
What about alcohol?
You can drink alcohol with golimumab. However this can cause liver dysfunction, particularly if taken together with methotrexate. Thus if you are drinking alcohol, only take in moderation.
Where can I get further information?
You can get more information from your doctor or rheumatology specialist nurse.
References available on request
Dr Christopher Edwards MD FRCP & Dr Warren Fong
Original article: 06/09/2011
Next review due: 19/08/2017