Early dose optimization of golimumab in nonresponders to induction treatment for ulcerative colitis is effective and supported by pharmacokinetic data.

BACKGROUND AND AIMS: In nonresponders to golimumab induction for ulcerative colitis, we assessed clinical response rates and golimumab serum concentrations when the 100 mg dose is used early in the course of maintenance.Methods: This post-hoc analysis of golimumab maintenance dosing (in the PURSUIT-M study) examined clinical outcomes and golimumab concentrations in early (Week 6) responders and nonresponders to induction, including subgroups based on body weight.

RESULTS: In nonresponders to golimumab induction (assessed at Week 6), the 100 mg maintenance dose (starting at Week 6) resulted in a meaningful proportion (28.1%) of patients achieving a partial Mayo response at Week 14. After 1 year of maintenance, clinical outcome (response, remission, mucosal healing, corticosteroid-free state) rates in these "late" (Week 14) responders were similar to those in early (Week 6) responders. Golimumab concentrations in early nonresponders were approximately half those of early responders, suggesting early nonresponders had more rapid golimumab clearance. Examined by body weight, the early nonresponders weighing <80 kg and receiving 100 mg had golimumab concentrations similar to the early responders (weighing <80 kg or 80 kg and receiving 50 mg or 100 mg, respectively).

CONCLUSION: Early use of the 100 mg maintenance dose leads to positive clinical outcomes in a meaningful proportion of patients who did not respond to golimumab at Week 6. Early nonresponders <80 kg who received the 100 mg maintenance dose achieved adequate golimumab concentrations and a clinically meaningful proportion of these patients had a late clinical response.PURSUIT-M protocol number C0524T18; ClinicalTrials.gov, NCT00488631; EudraCT, 2006-003399-37.