Golimumab

• You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
• You should have regular blood tests as suggested by your rheumatologist.
• It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• If you stop golimumab for any reason, you must contact your rheumatologist. Failure to do so may mean that your treatment may no longer be subsidised.
• If you plan to become pregnant, you must discuss the timing with your rheumatologist

Golimumab can help people with inflammatory arthritis live longer with a better quality of life. Studies show that patients who take golimumab have a lower risk of death and fewer flares. 
Many patients with inflammatory arthritis experience reduced pain, swelling, and stiffness. Golimumab helps to slow or stop disease progression and prevent joint or organ damage. This can enhance mobility and reduce disability caused by the condition. You may notice lessening of joint swelling, pain and stiffness, often within the first 8 weeks of starting. It is important to continue taking the medicine as prescribed to see full benefits.

• If you stop or delay your golimumab treatment, your condition may worsen again. Continue with your treatment, unless told by your rheumatologist to stop or unless side effects occur (see Side effects).
• If you stop golimumab for any reason, you must contact your rheumatologist. Failure to do so may mean that your treatment may no longer be funded

• Medicines like golimumab are very expensive and highly subsidised by Medicare. Certain conditions must be met to receive it.
• Golimumab will only be given if your disease is active and if standard treatments have not worked.
• It will only be kept going if it helps your condition. This must be checked between 12 and 16 weeks after the start of treatment.
• Blood tests are needed during your treatment to watch for side effects and decide if the treatment is working.
• How often you have blood tests will depend on what other medicines you are taking and what other illnesses you might have. Your rheumatologist will advise on this.

• Golimumab is injected under the skin of the abdomen or thigh. It comes in a pen or a syringe injection.
• It can be injected by your doctor, nurse, carer or by you. If injecting yourself, be sure to follow the detailed instructions carefully to ensure the best response. It is very important to change where you inject each time.

• The usual dose for adults is 50mg once every four weeks.

Golimumab may be used with other arthritis medicines including:

• other DMARDs such as methotrexate
• steroid medicines such as prednisolone or cortisone injections into the joint
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen, Nurofen)
• simple pain medicines such as paracetamol.

Golimumab cannot be used with other bDMARDs.

There are separate information sheets for the medicines mentioned above.

You might experience side effects with your treatment. Contact your rheumatologist if you have any concerns about possible side effects. Many side effects disappear when golimumab treatment is stopped.

Most common possible side effects

• Mild pain, swelling or itching at the site of the injection are very common (up to 20% of patients) but can be reduced by applying ice and antihistamine/steroid creams to the injection site and/or leaving the medicine out of the refrigerator for 30 minutes before injecting.
• Headaches, cough, stomach and bowel discomfort may also occur.
• As golimumab affects the immune system, mild infections, mainly the upper respiratory tract (e.g. colds, sinusitis) may occur more often. Treatment with golimumab may need to be briefly stopped for a serious infection so contact your rheumatologist for advice.

Less common or rare possible side effects

• Serious infections such as tuberculosis (TB) are seen rarely, and screening for TB is needed before treatment begins.
• Rarely, golimumab may cause an allergic reaction with itchy, red skin or a rash or a feeling of tightness in the chest and trouble breathing.
• Side effects involving the nerves, such as inflammation of the nerve to the eye, may also occur rarely, causing changes in vision or sensation.
• Very rarely ‘drug-induced lupus’ has occurred with symptoms of rash, fever and increased joint pain.
• Annual skin checks are suggested with any medicines that can suppress the immune system as there is a slight increase in risk in skin cancers. Current research and use over 20 years, have not shown an increase in risk of other cancers.

Infections

• If you have a current infection of any kind, treatment with golimumab should not be given until the infection is treated.
• You will need some blood tests and a chest X-ray to exclude some chronic infections before your first bDMARD.

Use with other medical conditions
Worsening may occur of the following conditions:

• multiple sclerosis.
• moderate to severe heart failure.
• systemic lupus erythematosus (lupus/SLE) People with SLE are not often given golimumab but each case will be assessed whether safe by your rheumatologist.

Use with other medicines

• Golimumab can interact with other medicines. You should tell all your doctors about all medicines you are taking or plan to take. This includes over-the-counter or herbal/naturopathic medicines.

Vaccines

• If you are taking golimumab you should not be immunised with ‘live’ vaccines such as:
  • MMR (measles, mumps and rubella), Varicella vaccine (Chicken pox), OPV (oral polio virus), BCG (Bacillus Calmette Guerin), Japanese Encephalitis or Yellow Fever. Talk with your rheumatologist before receiving any vaccines.
• COVID-19, pneumococcal vaccines and the yearly seasonal flu vaccinations are safe and encouraged.
• For more information is available on Vaccinations in Rhematology and respiratory infections including COVID-19.

Surgery

• You might need to stop taking golimumab for a short time before and after surgery, especially if you have a higher risk of infection or if getting an infection could cause serious problems. Talk to your rheumatologist before having any surgery. 

Use with alcohol

• You may drink alcohol while taking golimumab. If you are also taking methotrexate, you should be cautious about how much alcohol you drink.

Use in pregnancy and when breastfeeding

• It is important to discuss with you doctor if you are planning a pregnancy while on golimumab.
• It may be used in pregnancy and in men trying to father a child.
• If golimumab is continued beyond 4 months of pregnancy, it may increase the risk of infection in the newborn when live vaccines may be due. 
• The rotavirus vaccine should be given within the first 6 months of life. MMR may be given at 6 months. Discussion with a neonatalogist/paediatrician is recommended. 
• There is only limited information regarding golimumab in breastmilk and while small amounts may occur, it does not seem to be harmful.

• Golimumab should normally be kept refrigerated; however if needed, for example when travelling, it may be stored below 25°C for up to 4 weeks and then used or discarded.
• Keep all medications out of reach of children.