Golimumab Demonstrates High Remission Rates in Early Axial Spondyloarthritis

A recent clinical study led by Dr. Zuzanna Łukasik and Dr. Ann-Sophie De Craemer at Gent University Hospital, Belgium, has highlighted the effectiveness of golimumab in inducing sustained clinical remission in patients with early, active axial spondyloarthritis (axSpA). The findings were published in the journal Arthritis & Rheumatology on June 16, 2025, and represent a significant advancement in the management of this chronic inflammatory condition.

In this multicenter, single-arm trial, researchers evaluated the impact of a tight control strategy that included rapid escalation to tumor necrosis factor (TNF) inhibition. The study cohort comprised 58 patients, with a mean age of 28.2 years and 41.4% being female. Inclusion criteria required participants to have an Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) of 2.1 or higher, and symptom duration of less than one year.

Patients were initially treated with two different nonsteroidal anti-inflammatory drugs (NSAIDs) for four weeks. If necessary, they would then receive 50 mg of golimumab every four weeks until achieving inactive disease, defined as an ASDAS-CRP score of less than 1.3. The primary endpoint was the proportion of patients achieving sustained clinical remission, which necessitated achieving an ASDAS-CRP score of less than 1.3 at two consecutive visits over a 12-week interval.

The results were promising: 61.8% of participants achieved sustained clinical remission. Among those who required escalation to golimumab, 55% successfully reached this remission threshold. Notably, microscopic gut inflammation was identified in 28.6% of patients, but it did not significantly predict the likelihood of achieving clinical remission, with an odds ratio of 1.50 (95% CI, 0.39-6.49).

The study also found that relapse rates were notably high; 78.1% of patients who discontinued treatment experienced a relapse within one year. However, relapse rates were lower for those who maintained treatment—91.7% for NSAIDs and 70% for golimumab. Factors that correlated with sustained remission included male sex, a non-smoking history, and lower disease activity.

Dr. Łukasik emphasized, "Our trial demonstrated that sustained inactive disease state is an achievable therapeutic goal in early axSpA. This is particularly relevant as early intervention is crucial in managing the long-term outcomes of patients with this condition."

Despite the positive findings, the study faced limitations, including difficulties in recruiting patients within the critical first year of symptom onset, which led to a high screening failure rate. Furthermore, repeated ileocolonoscopy at remission was performed in only a minority of patients, restricting the analysis regarding the relationship between axial symptoms and gut inflammation.

This research was supported by a grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp., with some authors disclosing educational and research funding from the company. These findings underscore the potential for golimumab as a cornerstone in the treatment strategy for axial spondyloarthritis, particularly in fostering early intervention to improve patient outcomes and quality of life.

In conclusion, the study offers a promising outlook for patients suffering from axSpA, suggesting that tailored treatment strategies that prioritize rapid response and tight control could significantly enhance remission rates. Further research is warranted to explore the long-term implications of such treatment approaches and their effectiveness in diverse patient populations.