Revisión sistemática
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Objective. To assess the safety and efficacy of golimumab in methotrexate (MTX)-naive patients with active rheumatoid arthritis (RA). Methods. MTX-naive patients with RA (n = 637) were randomized to receive placebo plus MTX (group 1), golimumab 100 mg plus placebo (group 2), golimumab 50 mg plus MTX (group 3), or golimumab 100 mg plus MTX (group 4). Subcutaneous injections of golimumab or placebo were administered every 4 weeks. The dosage of MTX/placebo capsules started at 10 mg/week and escalated to 20 mg/week. The primary end point, the proportion of patients meeting the American College of Rheumatology 50% improvement criteria (achieving an ACR50 response) at week 24, required significant differences between groups 3 and 4 combined (combined group) versus group 1 and significant differences in a pairwise comparison (group 3 or group 4 versus group 1). Results. An intent-to-treat (ITT) analysis of the ACR50 response at week 24 did not show a significant difference between the combined group and group 1 (38.4% and 29.4%, respectively; P = 0.053), while a post hoc modified ITT analysis (excluding 3 untreated patients) of the ACR50 response showed statistically significant differences between the combined group and group 1 (38.5% versus 29.4%; P = 0.049) and between group 3 (40.5%; P = 0.038) but not group 4 (36.5%; P = 0.177) and group 1. Group 2 was noninferior to group 1 for the ACR50 response at week 24 (33.1%; 95% confidence interval lower bound -5.2%; predefined delta value for noninferiority -10%). The combination of golimumab plus MTX demonstrated a significantly better response compared with placebo plus MTX in most other efficacy parameters, including response/remission according to the Disease Activity Score in 28 joints. Serious adverse events occurred in 7%, 3%, 6%, and 6% of patients in groups 1, 2, 3, and 4, respectively. Conclusion. Although the primary end point was not met, the modified ITT analysis of the primary end point and other prespecified efficacy measures demonstrated that the efficacy of golimumab plus MTX is better than, and the efficacy of golimumab alone is similar to, the efficacy of MTX alone in reducing RA signs and symptoms in MTX-naive patients, with no unexpected safety concerns. © 2009, American College of Rheumatology.
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Revisión sistemática
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Background: Golimumab (GOL) is a tumor necrosis factor inhibitor that is used for various types of inflammatory arthritis such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). This article is a systematic review of the evidence for the efficacy and safety of golimumab in inflammatory arthritides, specifically RA, PsA and AS. Methods: We conducted a search of randomized controlled trails in MEDLINE [PubMed], CENTRAL, Embase, and Current Controlled Trials databases (ClinicalTrials.gov) through 2017 for studies that evaluated golimumab in inflammatory arthritides. We focused on pivotal, phase III trials for this review of the safety and efficacy of the drug. However, as some important information is not available in detail in publications from the phase III studies, additional individual studies pertaining to antidrug antibodies were also included. Results: A total of 12, randomized, double-blind, placebo-controlled studies were included in this review of literature. Two trials focused on the GOL response in the PsA population, four trials focused on the GOL response in the AS population, and five trials focused on the GOL response in the RA population. Additional studies that evaluated autodrug antibodies produced in patients using GOL were also included. Conclusion: Golimumab was found to be clinically effective and also have a good safety profile in the treatment of RA, PsA, and AS based on data available from large studies.
Revisión sistemática
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Golimumab is a fully human antitumor necrosis factor alpha (TNF-alpha) monoclonal antibody that is being developed for intravenous and subcutaneous administration. To assess the pharmacokinetics and safety of the intravenous formulation of golimumab, 36 adult subjects with rheumatoid arthritis were randomly assigned to receive a single infusion of placebo or golimumab (0.1, 0.3, 1, 3, 6, or 10 mg/kg). Serum concentrations of golimumab were determined using a validated enzyme-linked immunosorbent assay method. In addition to the noncompartmental analysis and compartmental modeling, a population pharmacokinetics analysis using NONMEM was also conducted. Both the maximum serum concentration and the area under the serum concentrationtime curve appeared to increase in a dose-proportional manner. The median half-life ranged from 7 to 20 days. A 2-compartment population pharmacokinetic model adequately described the pharmacokinetics of golimumab. The following pharmacokinetic parameters (typical value [% coefficient of variation]) were estimated from the population pharmacokinetic model: clearance (CL= 0.40 [10.1%] L/d), volume of distribution in the central compartment (V(c): 3.07 [6.4%] L), intercompartmental clearance (Q: 0.42 [15.5%] L/d), and volume of distribution in the peripheral compartment (V(p): 3.68 [11.8%] L). Interindividual variability of the pharmacokinetic parameters was quantified for CL (44.3%), V(c) (25.5%), Q (44.6%), and V(p) (44.6%). Residual variability was estimated to be 15.0%. Body weight was found to be an important covariate on V(c). Golimumab was generally well tolerated. The pharmacokinetics of golimumab appeared to be linear over the dose range evaluated in this study.
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Intravenous golimumab in a dosage of 2 mg/kg, initially given every 4 weeks but then every 8 weeks, in addition to methotrexate, is effective in the treatment of patients with rheumatoid arthritis. This weight-based infusion is administered over thirty minutes with an acceptable safety profile. Since it is a relatively new formulation, more time will be required to assess its specific role in the rheumatologists' armamentarium and to appreciate more fully its long-term safety.
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Objectives: Immune-mediated rheumatic disease (IMRD) including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), are severe and disabling chronic diseases in rheumatology. Bioogics such as subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) have transformed the management of the diseases. The study objective was to describe treatment persistence in a real-world setting, among patients diagnosed with IMRD, initiating treatment with golimumab (GLM) in France. Methods: The Système National d'Information Inter-régime [French national health insurance scheme information-sharing system] database lists all outpatient and inpatient healthcare consumption for individuals covered by the general health insurance scheme. Patients with RA, PsA or AS were included through Long Term Disease (LTD) status and hospital admission, based on ICD-10 codes. Then, patients were then identified through filled prescription of GLM between 06/01/2012 and 12/31/2013. A sensitivity analysis was conducted on patients with no subcutaneous or intravenous biotherapy before initiating GLM. Persistence was estimated using Kaplan Meier analysis at 12 and 24 months. Results: A total of 1,315 patients initiating GLM with RA were identified, 2,656 with AS and 514 with PsA. For all IMRD patients (bionaïves or not) 12 months persistence rate was 54.7%. 12 month persistence rate was 56.6% for RA, 54.5% for AS and 50.8% for PsA. 24 month persistence rates were 40.1%, 41.0% and 35.0% for RA, AS and PsA, respectively. For all IMRD patients GLM persistence rates was 60.2% at 12 months and 47 % at 24 months. Persistence rate at 12 months was 63.8% in RA, 58.9% in AS and 55.9% in PsA; and 48.5% at 24 months in RA, and 44.1% in AS, and 57.1% in PsA. Conclusions: GLM persistence rates at 12 months are between 55% (bionaïve and bioswitch patients) and 60% (bionaïve patients only). Those results confirm persistence rates published in the literature at 12 months for naïve patients.