Clinical Efficacy and Factors Predictive of the Therapeutic Effect of the TNF Inhibitor Golimumab in Patients with Rheumatoid Arthritis

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  • SUGISAKI NAGACHIKA
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • TADA KURISU
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • ABE YOSHIYUKI
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • OGASAWARA MICHIHIRO
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • MATSUDAIRA RAN
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • YAMAJI KEN
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
  • TAKASAKI YOSHINARI
    Department of Internal Medicine and Rheumatology, Juntendo University Koshigaya Hospital
  • TAMURA NAOTO
    Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine

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<p>Objectives: To examine the clinical efficacy and factors predictive of the therapeutic effect of golimumab in patients with rheumatoid arthritis (RA). </p><p>Methods: This single-center, prospective observational study enrolled in 2011 to 2015 all 71 (male 7 cases / female 64 cases) patients with RA treated with golimumab. Disease activity at 52 weeks was assessed by the disease activity score in 28 joints (DAS28) and the simplified disease activity index (SDAI). The variables at baseline, including patient demographics, clinical characteristics were analyzed for their association with clinical remission at 52 weeks.</p><p>Results: Seventy-one patients were registered. Reduction of disease activity was recognized as early as 4 weeks after the commencement of golimumab, and DAS28 remission at 52 weeks was observed in 43.3% of the patients. Golimumab was more effective in patients who were naïve for biological disease-modifying anti-rheumatic drugs (bDMARDs) than previously treated with bDMARDs, although bDMARDs naïve and switch both groups had similar rates of radiographic progression. When baseline variables were compared between remission and non-remission patients at 52 weeks, the remission group had shorter disease duration, less radiographic progression, higher concomitant methotrexate dose, and lower steroid dose. Multivariate analysis revealed that lower stages and classes in Steinbrocker’s classification, and higher dose of methotrexate at baseline, were independent factors for DAS28 remission at 52 weeks.</p><p>Conclusions: Rapid and sustained reduction of disease activity was observed in RA patients treated with golimumab. Clinical remission may be achieved more frequently when golimumab is started early in the disease course with an adequate dose of methotrexate, especially in patients who were naïve to bDMARDs.</p>

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