golimumab
Summary
Golimumab is a human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-α), used to treat autoimmune inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. It is administered via subcutaneous or intravenous injection and carries an increased risk of infections, including reactivation of latent tuberculosis.
Detail
Golimumab is a fully human IgG1 monoclonal antibody that binds to both soluble and transmembrane forms of TNF-α, neutralizing its biological activity and preventing it from binding to its receptors. TNF-α is a key pro-inflammatory cytokine involved in the pathogenesis of several autoimmune diseases, so blocking it reduces inflammation, joint damage, and disease progression.
Mechanism: By inhibiting TNF-α, golimumab decreases downstream inflammatory signaling, reduces recruitment of leukocytes to sites of inflammation, and decreases production of other pro-inflammatory cytokines (IL-1, IL-6) and adhesion molecules.
Clinical uses (FDA-approved): Rheumatoid arthritis (in combination with methotrexate), psoriatic arthritis, ankylosing spondylitis, and moderate-to-severe ulcerative colitis. It is typically given as a once-monthly subcutaneous injection or intravenous infusion every 8 weeks.
Adverse effects/boards-relevant points: - Increased risk of serious infections, including reactivation of latent tuberculosis (screen with PPD/IGRA before starting) and invasive fungal infections (e.g., histoplasmosis). - Risk of hepatitis B reactivation—screen before initiation. - Increased risk of malignancies, particularly lymphoma (boxed warning, especially in pediatric/adolescent patients when combined with other immunosuppressants). - Can cause or worsen heart failure—use with caution in patients with pre-existing heart failure. - Demyelinating disease exacerbation (e.g., multiple sclerosis)—use with caution. - Injection site reactions, headache. - Contraindicated in patients with active serious infections.
Boards high-yield comparison: Golimumab belongs to the class of anti-TNF biologics, which includes infliximab, adalimumab, certolizumab pegol, and etanercept (though etanercept is a fusion protein, not a monoclonal antibody, and works differently as a decoy receptor). Understanding the shared risks (infection, TB reactivation, lymphoma risk, heart failure exacerbation) across this drug class is important for USMLE Step 1 and Step 2.
Sources
- First Aid for the USMLE Step 1
- Katzung's Basic and Clinical Pharmacology
- UpToDate: TNF-alpha inhibitors
- FDA prescribing information for golimumab (Simponi)
Reviewed by AnkiBoss editorial — medical student review. Information here is for study reference only and is not medical advice. Spotted an error? Let us know.