Golimumab in unresponsive ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines) and the biologics providing blockade of tumor necrosis factor (TNF), the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC.

Keywords: anti-TNF; biological therapy; inflammatory bowel disease.

Figure 1

Golimumab responses in patients with UC to golimumab or placebo at week 6 (clinical response). Note: Reprinted from Gastroenterology, 146(1), Sandborn WJ, Feagan BG, Marano C, et al, Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis, 85–95, Copyright © (2014), with permission from Elsevier. Abbreviation: UC, ulcerative colitis.

Figure 2

Clinical response, clinical remission, and mucosal healing, with golimumab in the maintenance therapy. Note: Reprinted from Gastroenterology, 146(1), Sandborn WJ, Feagan BG, Marano C, et al, Subcutaneous golimumab maintains clinical response in patients with moderate-to-severe ulcerative colitis, 96–109. e1, Copyright © (2014), with permission from Elsevier.