Golimumab and Methotrexate Are Both Disease-Modifying Antirheumatic Drugs (DMARDs)
Yes, both golimumab and methotrexate are disease-modifying antirheumatic drugs (DMARDs), but they belong to different categories within the DMARD classification. 1
Classification of DMARDs
DMARDs are categorized into different types based on their mechanism of action and molecular structure:
Methotrexate
- Methotrexate is classified as a conventional synthetic DMARD (csDMARD) 1
- It is an antimetabolite that acts by inhibiting dihydrofolate reductase, affecting DNA synthesis and cellular replication 2
- Methotrexate is considered the anchor drug and first-line therapy for rheumatoid arthritis 1
- It is often used as monotherapy or in combination with other DMARDs 3
Golimumab
- Golimumab is classified as a biologic DMARD (bDMARD) 1
- Specifically, it is a TNF inhibitor (TNFi), which is a subclass of bDMARDs 1
- It is a human anti-TNF monoclonal antibody that acts by targeting and neutralizing tumor necrosis factor (TNF) 4, 5
- Golimumab is typically used after inadequate response to csDMARDs or in combination with methotrexate 6, 7
Role in Treatment Algorithms
Methotrexate
- Methotrexate should be part of the first treatment strategy for rheumatoid arthritis 1
- It is the preferred initial DMARD for most patients with RA 1
- Optimal dosing is 25-30 mg weekly with folate supplementation 1
- Maximum effect may take 4-6 months to achieve 1
Golimumab
- Golimumab is typically used after failure of or in combination with csDMARDs 1
- It is administered subcutaneously or intravenously, usually in combination with methotrexate 4, 7
- Golimumab is one of several TNF inhibitors (along with adalimumab, certolizumab, etanercept, and infliximab) that can be used when csDMARDs are insufficient 1
Combination Therapy
- The combination of methotrexate with a bDMARD like golimumab is often recommended for patients with moderate to high disease activity and poor prognostic factors 1
- Methotrexate enhances the efficacy of TNF inhibitors like golimumab and reduces the development of neutralizing antibodies 4, 7
- In clinical trials, golimumab plus methotrexate was more effective than methotrexate alone for improving signs and symptoms of arthritis 4
Important Considerations
- While both are DMARDs, they have different safety profiles and monitoring requirements 2, 4
- Methotrexate requires regular monitoring of complete blood count, liver function, and renal function 2
- TNF inhibitors like golimumab require screening for tuberculosis and monitoring for infections 1
- The choice between different DMARDs should be based on disease activity, prognostic factors, and previous treatment response 1
Common Pitfalls to Avoid
- Not recognizing that DMARDs include both synthetic and biologic agents 1
- Failing to distinguish between conventional synthetic DMARDs (like methotrexate) and biologic DMARDs (like golimumab) when discussing treatment options 1
- Overlooking the synergistic effect when combining methotrexate with TNF inhibitors like golimumab 4, 7
- Not considering that some patients may receive golimumab without methotrexate if they have contraindications to methotrexate 7