Can a Symponi (golimumab) injection 11 weeks ago cause immunocompromise, predisposing to COVID-19?

Golimumab (Symponi) and COVID-19 Risk After 11 Weeks

A Symponi (golimumab) injection received 11 weeks ago does still cause some degree of immunosuppression, potentially increasing your susceptibility to COVID-19 infection and its complications. 1, 2

Mechanism and Duration of Immunosuppression

Golimumab is a TNF-inhibitor that affects your immune system by blocking tumor necrosis factor (TNF), an important inflammatory cytokine. This medication has several important considerations regarding COVID-19 risk:

• The FDA label for Symponi clearly states that "patients treated with SIMPONI are at increased risk for developing serious infections" which can lead to hospitalization or death 1
• The immunosuppressive effects of golimumab persist throughout the dosing interval, which is typically every 4 weeks for subcutaneous injections 1
• At 11 weeks post-injection, you are approximately 7 weeks beyond the typical dosing interval, but some immunosuppressive effects may still be present

COVID-19 Risk in Patients on TNF Inhibitors

According to guidelines from the British Society of Gastroenterology:

• There is "no current evidence of increased risk of COVID-19 infection" specifically from anti-TNF therapy 2
• However, the FDA label warns that patients on TNF inhibitors like golimumab may be at "greater risk of infection" 1
• The Journal of Crohn's and Colitis notes that while IBD patients on immunosuppressants have increased risks for various infections, "there is no evidence that IBD patients with COVID have worse outcomes if they receive these drugs" 2

Risk Assessment Factors

Several factors influence your current level of risk:

1. Time since last injection: At 11 weeks post-injection, the immunosuppressive effect is likely diminished but not completely gone
2. Underlying condition: The condition for which you're receiving golimumab affects your baseline risk
3. Age and comorbidities: Older age (>60 years) and pre-existing conditions increase risk 2
4. Vaccination status: COVID-19 vaccination is recommended for patients on immunosuppressive therapies 2, 3

Recommendations

Based on the current evidence:

1. Continue COVID-19 precautions: Since you likely still have some degree of immunosuppression, maintain appropriate preventive measures (masking in high-risk settings, hand hygiene, etc.) 2

2. Consider vaccination status: If you haven't been fully vaccinated against COVID-19, guidelines strongly recommend vaccination for immunocompromised individuals 3

3. Monitor for symptoms: Be vigilant for any signs of infection and seek prompt medical attention if symptoms develop 1

4. Consult your specialist: Your rheumatologist or gastroenterologist can provide personalized guidance based on your specific medical history and current disease activity

Important Caveats

• The degree of immunosuppression varies between individuals and depends on other medications you may be taking (especially if combined with other immunosuppressants) 2
• Recent evidence suggests that while TNF inhibitors cause immunosuppression, they may potentially have beneficial effects in severe COVID-19 by dampening the hyperinflammatory response ("cytokine storm") that can occur 2, 4
• The risk-benefit calculation remains in favor of continuing necessary immunosuppressive therapy in most cases 2

Remember that while golimumab does cause some immunosuppression even 11 weeks after injection, following appropriate precautions and staying up-to-date with COVID-19 vaccination can help mitigate this risk.