The Unfinished Symphony: Golimumab Therapy for Anti-Tumour Necrosis Factor Refractory Crohn's Disease.

Abstract

BACKGROUND AND AIMS:

Golimumab is approved for the treatment of moderate-to-severely active ulcerative colitis. However, there have been no formal trials to assess its utility in Crohn's disease [CD]. Our aim was to determine the efficacy and safety of golimumab in patients with anti-tumour necrosis factor [TNF] refractory CD.

METHODS:

Patients with CD treated with golimumab between 2010 and 2017 were included in a retrospective observational study. The vast majority of patients failed two anti-TNF agents. Clinical response was defined as a significant reduction in symptoms and biochemical markers of CD, and no requirement for surgery or introduction of immune-suppressants.

RESULTS:

Forty-five patients were included, with a median follow-up of 22 months [interquartile range 12-34] following initiation of golimumab. Induction and maintenance regimens were generally higher than standard dosing with first month cumulative doses of 400 mg and above in 75% of the patients. Monthly maintenance doses ≥200 mg were administered in 52% of patients. Clinical response at 3 months was achieved in 35/45 [77.7%] patients. The cumulative probabilities that patients with an initial response maintained their clinical response for 12 and 36 months after introduction of golimumab were 81% and 64%, respectively. Endoscopic improvement and mucosal healing at 12 months was achieved in 73% and 47% of patients, respectively.

CONCLUSIONS:

This study demonstrates the efficacy of golimumab in anti-TNF refractory CD patients. Further studies should be performed in CD to formally assess the efficacy of golimumab in a randomized controlled trial and to establish the optimal dosing regimen.

• Authors: Tomer Greener, Karen Boland, A Hillary Steinhart, Mark S Silverberg
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 12 Issue 4 Pg. 458-464 (Mar 28 2018) ISSN: 1876-4479 [Electronic] England
• PMID: 29293965 (Publication Type: Journal Article, Observational Study)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Tumor Necrosis Factor-alpha
• golimumab
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Crohn Disease (diagnostic imaging, drug therapy)
• Endoscopy, Gastrointestinal
• Female
• Gastrointestinal Agents (adverse effects, therapeutic use)
• Humans
• Induction Chemotherapy
• Infliximab (therapeutic use)
• Maintenance Chemotherapy
• Male
• Remission Induction
• Retreatment
• Retrospective Studies
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)