Golimumab is an anti TNF which has been approved by NICE for AS.
Golimumab is given by a once monthly injection under the skin using a pre-filled 'pen' device. The injections usually go under the skin of the thigh or the tummy.You, your partner, or another member of your family can learn to give the injections. If this is not possible, the injections can be given by your rheumatology specialist nurse or a district nurse.
If you are being prescribed golimumab, it is recommended that you carry a biological therapy alert card, which you can obtain from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on golimumab and that you are therefore at risk of its side-effects, including infections.
Time golimumab takes to work
If you respond to golimumab, your symptoms will start to improve in 12-14 weeks; that is after 3-4 doses. If you weigh more than 100 kg (around 15 stone 10 lb) and you have not responded to golimumab, your doctor may consider increasing the dose of golimumab to 100 mg per month for 3 or 4 more injections.
- Reactions at the injection site such as redness, swelling or pain may occur. These reactions are usually not serious.
- Golimumab lowers the immune system so you may be more likely to develop infections. Avoid close contact with people with infections and be extra careful with food safety.
- Contact your doctor or rheumatology nurse straight away if you develop any of the following symptoms:
- sore throat
- other symptoms of infection
- any other new symptoms or anything that concerns you.
You should see your doctor immediately if:
- any of the symptoms listed above are persistant or severe
- you have never had chickenpox and you come into contact with someone who has chickenpox or shingles
- you develop chickenpox or shingles.
Chickenpox and shingles can be severe in people who are on treatments such as golimumab which affect the immune system. You may need antiviral treatment which your doctor will be able to prescribe and you will need to stop golimumab until you are better.
Rarely people may experience an allergic reaction to golimumab. If the reaction is severe the drug may have to be stopped.
Potential risks associated with golimumab
There may be a slightly increased risk of some cancers with adamilumab as it interferes with the immune system. This is theoretically possible because the immune system is involved in recognising and killing cancerous cells. It's important to bear in mind that this link hasn't been proven and is still being extensively researched. A a review in 2012 of studies involving over 25,000 patients found no increase in the risk of cancer.
Very rarely, people taking golimmumab may develop a condition called drug induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, the adalimumab will be stopped and the condition then usually disappears
If you're taking golimumab it's recommended that you avoid live vaccines such as yellow fever. If you do need a live vaccine do discuss all the possible risks and benefits of the vaccination with your doctor.
If you're in your 70s your doctor may advise you to have the shingles vaccination (Zostavax) before starting golimumab. This vaccination is not recommended for people who are already on golimumab.
Pneumovax (pneumonia) and yearly flu vaccines are recommended for everyone on golimumab
Golimumab may be prescribed along with other medications. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking golimumab.
Golimumab is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as golimumab, unless your doctor advises otherwise.
Do not take over-the-counter preparations (other than paracetamol) or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.
There is no known interaction between golimumab and alcohol.
Golimumab and surgery
If you are going to have an operation please inform your doctor, as you are likely to be advised to stop the golimumab temporarily before and after surgery.
Golimumab and fertility or pregnancy
The British Society for Rheumatology produced new guidelines on the use of anti TNF therapy such as golimumab during pregnancy.
Golimumab and travelling
If you are travelling abroad and taking your anti TNF therapy with you, it's important to make plans to keep it at the correct temperature during the journey and at your destination. You can buy special cool bags and even travel fridges. A useful company to try to purchase these products is MedActiv.
Another option is to use a Frio wallet or carry case. These are designed to keep insulin cool but work well for anti TNF. You can buy these through Amazon.
In addition to your anti TNF medication you may require a travel size sharps box. Do discuss this with your Clinical Nurse Specialist or your delivery team.
There's more travel tips in the `Living with AS` section of the website.
If you are going to have an operation please inform your doctor, as you may be advised to stop golimumab temporarily before and after surgery.
Golimumab may take up to 5 months to be eliminated from the body; therefore even if you stop taking golimumab your immune system may be impaired for several weeks. This may be relevant if you are about to have surgery.
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