Baseline demographic and disease characteristics
The GO-FURTHER study was conducted at 92 sites in 13 countries (Argentina, Australia, Columbia, Hungary, Korea, Lithuania, Malaysia, Mexico, New Zealand, Poland, Russia, Ukraine, and the USA). Patients were randomized to receive placebo plus MTX (
n = 197) or golimumab plus MTX (
n = 395) at baseline. Demographic and disease characteristics were well-balanced between the treatment groups [
18]. In this analysis, there were 515 patients aged < 65 years and 77 patients ≥ 65 years. Baseline demographics and disease characteristics for these patients are reported in Table
1. As expected, the mean ages differed between patients < 65 years and those ≥ 65 years. The proportions of patients receiving oral corticosteroids, NSAIDs, and DMARDs were lower among those aged ≥ 65 years. Patients ≥ 65 years had a longer mean RA disease duration and a slightly lower mean dose of oral corticosteroids at baseline compared with patients < 65 years. MTX use was categorized by time periods of (< 1 year, 1 to < 3 years, ≥ 3 years), and a greater proportion of younger patients seemed to be receiving MTX for longer than 3 years compared with patients ≥ 65 years. Other demographic and disease characteristics, including the ACR core assessments, were similar between these patient age groups.
Table 1
Baseline demographic and disease characteristics for patients < 65 years and ≥ 65 years
Patients, n | 179 | 336 | 515 | 18 | 59 | 77 |
Age, years | 49.5 ± 9.9 | 48.7 ± 10.7 | 49.0 ± 10.4 | 70.4 ± 3.4 | 70.1 ± 4.3 | 70.2 ± 4.1 |
Female | 141 (78.8) | 276 (82.1) | 417 (81.0) | 16 (88.9) | 50 (84.7) | 66 (85.7) |
Race |
Caucasian | 145 (81.0) | 272 (81.2) | 417 (81.1) | 15 (83.3) | 43 (72.9) | 58 (75.3) |
Asian | 10 (5.6) | 30 (9.0) | 40 (7.8) | 2 (11.1) | 1 (1.7) | 3 (3.9) |
Black | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (1.7) | 1 (1.3) |
Other | 24 (13.4) | 33 (9.8) | 57 (11.1) | 1 (5.6) | 14 (23.7) | 15 (19.5) |
Weight, kg | 71.7 ± 17.4 | 72.4 ± 16.2 | 72.2 ± 16.6 | 73.8 ± 15.3 | 66.3 ± 14.3 | 68.1 ± 14.7 |
BMI, kg/m2 | 26.9 ± 5.7 | 27.0 ± 5.6 | 27.0 ± 5.6 | 28.3 ± 5.5 | 25.8 ± 4.9 | 26.4 ± 5.1 |
RA disease duration | 6.6 ± 6.3 | 6.5 ± 6.3 | 6.5 ± 6.3 | 10.8 ± 13.1 | 9.3 ± 9.8 | 9.7 ± 10.6 |
ACR core components |
Number of swollen joints (0–68) | 14.7 ± 8.4 | 15.0 ± 8.5 | 14.9 ± 8.5 | 15.9 ± 9.8 | 14.6 ± 6.2 | 14.9 ± 7.2 |
Numbers of tender joints (0–68) | 25.9 ± 14.3 | 26.6 ± 13.7 | 26.3 ± 13.9 | 25.8 ± 12.8 | 25.5 ± 15.2 | 25.6 ± 14.6 |
CRP, mg/dL | 2.3 ± 1.9 | 2.8 ± 2.7 | 2.6 ± 2.5 | 1.5 ± 1.1 | 3.1 ± 3.7 | 2.7 ± 3.4 |
Physician’s global assessment (VAS, 0–10 cm) | 6.3 ± 1.5 | 6.3 ± 1.6 | 6.3 ± 1.6 | 5.9 ± 2.0 | 6.0 ± 1.7 | 5.9 ± 1.7 |
Patient’s global assessment (VAS, 0–10 cm) | 6.5 ± 1.9 | 6.5 ± 1.8 | 6.5 ± 1.9 | 6.2 ± 2.2 | 6.3 ± 1.8 | 6.3 ± 1.9 |
Patient’s assessment of pain (VAS, 0–10 cm) | 6.5 ± 2.0 | 6.5 ± 1.9 | 6.5 ± 1.9 | 6.6 ± 2.0 | 6.5 ± 1.6 | 6.5 ± 1.7 |
HAQ-DI | 1.60 ± 0.60 | 1.55 ± 0.66 | 1.56 ± 0.64 | 1.35 ± 0.72 | 1.61 ± 0.71 | 1.55 ± 0.72 |
Anti-CCP antibodies | 165/177 (93.2) | 307/335 (91.6) | 472/512 (92.2) | 16 (88.9) | 55 (93.2) | 71 (92.2) |
Rheumatoid factor | 164 (91.6) | 309 (92.0) | 473 (91.8) | 17 (94.4) | 56 (94.9) | 73 (94.8) |
SF-36 PCS | 30.8 ± 7.2 | 31.0 ± 6.6 | 30.9 ± 6.8 | 31.7 ± 8.9 | 30.0 ± 7.8 | 30.4 ± 8.0 |
SF-36 MCS | 38.3 ± 11.7 | 36.8 ± 11.1 | 37.3 ± 11.3 | 41.0 ± 10.4 | 38.9 ± 11.1 | 39.4 ± 10.9 |
Concomitant medications |
MTX dose at screening | 16.7 ± 2.8 | 16.9 ± 2.9 | 16.8 ± 2.9 | 16.4 ± 2.9 | 16.3 ± 2.8 | 16.3 ± 2.8 |
Duration of MTX use |
< 1 year | 44 (24.6) | 82 (24.4) | 126 (24.5) | 4 (22.2) | 20 (33.9) | 24 (31.2) |
1 to < 3 years | 53 (29.6) | 97 (28.9) | 150 (29.1) | 8 (44.4) | 17 (28.8) | 25 (32.5) |
≥ 3 years | 82 (45.8) | 154 (45.8) | 236 (45.8) | 6 (33.3) | 22 (37.3) | 28 (36.4) |
Unknown | 0 (0.0) | 3 (0.9) | 3 (0.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Oral corticosteroids | 121 (67.6) | 221 (65.8) | 342 (66.4) | 13 (72.2) | 30 (50.8) | 43 (55.8) |
Dose (prednisone or equivalent), mg/day | 7.0 ± 2.5 | 7.1 ± 2.5 | 7.0 ± 2.5 | 6.9 ± 2.7 | 6.6 ± 2.7 | 6.7 ± 2.6 |
NSAIDs | 145 (81.0) | 280 (83.3) | 425 (82.5) | 11 (61.1) | 43 (72.9) | 54 (70.1) |
Prior medications |
DMARDs* | 83 (46.4) | 182 (54.2) | 265 (51.5) | 9 (50.0) | 24 (40.7) | 33 (42.9) |
Safety
Through week 24, nine patients (2.2%) in the golimumab plus MTX group discontinued study treatment due to an AE. Of these, six patients (1.8%) were < 65 years at baseline, and three (5.1%) were ≥ 65 years of age. Through week 52 in the golimumab plus MTX group, 11 patients (3.3%) < 65 years and four patients (6.8%) ≥ 65 years discontinued study treatment due to AEs; through week 112, 23 patients (6.8%) < 65 years and 9 patients (15.3%) ≥ 65 years discontinued study treatment due to AEs. Overall, 86 (16.7%) patients < 65 years and 20 (26.0%) patients ≥ 65 years discontinued study agent through week 112. The two most common reasons for discontinuation were AEs (n = 44; 6.2% of patients < 65 years, 15.6% of patients ≥ 65 years) and withdrawal of consent (n = 31; 5.2% of patients < 65 years, 5.2% of patients ≥ 65 years). Among patients < 70 years, 6.5% discontinued study agent due to an AE, and 5.4% withdrew consent; among patients ≥ 70 years, 21.1% discontinued due to an AE, 2.6% withdrew consent, and 2.6% discontinued due to lack of efficacy. Among patients < 75 years, 6.9% discontinued study agent due to an AE, and 5.3% withdrew consent; among patients ≥ 75 years, 40.0% discontinued due to an AE, and all other discontinuations were for reasons other than AEs, withdrawal of consent or lack of efficacy.
Infections were the most common type of AE through week 52. The incidence of infections was similar between patients < 65 years (214/508, 42.1%) and those ≥ 65 years (30/76, 39.5%) and between patients < 70 years (227/547, 41.5%) and ≥ 70 years (17/37, 45.9%). Patients ≥ 75 years had a higher incidence of infections through week 52 than did patients < 75 years (5/10, 50.0%, and 239/574, 41.6%, respectively); however, the number of patients ≥ 75 years was small. Similar results were observed for the incidence of infections through week 112 (Table
3). Through week 112, upper respiratory infections were the most common infection in patients < 65 years (
n = 67/508; 13.2%) and those ≥ 65 years (
n = 9/76; 11.8%). The incidence of cellulitis was slightly higher among patients ≥ 65 years (
n = 4/76, 5.3%) compared with those < 65 years (
n = 10/508, 2.0%). Among patients ≥ 65 years, other infections included fungal urinary tract infection (
n = 1) and septic arthritis (
n = 2). There were four cases of herpes zoster; three occurred in patients < 65 years and one in a patient ≥ 70 years, and none were classified as serious or severe. Among patients who received golimumab plus MTX, 16/508 (3.1%) patients < 65 years and 7/76 (9.2%) ≥ 65 years had an infusion reaction through week 112. Skin reactions were the most common type of reaction among patients < 65 years (
n = 5); vascular disorders (hypertension and flushing) were the most common reaction among patients ≥ 65 years (
n = 3). Two patients in each age group experienced an infusion reaction of headache. None were considered serious or severe. No patient aged ≥ 65 years discontinued golimumab therapy due to an infusion reaction; one golimumab-treated patient, aged 39 years, discontinued due to a nonserious infusion reaction (mild skin reaction).
Table 3
Adverse events through week 52 and week 112 for patients who received at least one administration of golimumab
Patients, n | 508 | 76 | 547 | 37 | 574 | 10 |
Through week 52 |
Mean duration of follow-up, weeks | 43.5 | 43.2 | 43.6 | 41.8 | 43.5 | 40.5 |
Mean number of golimumab infusions | 5.9 | 5.8 | 5.9 | 5.6 | 5.9 | 5.4 |
Patients with ≥ 1 AE | 355 (69.9) | 52 (68.4) | 379 (69.3) | 28 (75.7) | 397 (69.2) | 10 (100.0) |
Patients with infections | 214 (42.1) | 30 (39.5) | 227 (41.5) | 17 (45.9) | 239 (41.6) | 5 (50.0) |
Patients with ≥ 1 SAE | 45 (8.9) | 9 (11.8) | 49 (9.0) | 5 (13.5) | 50 (8.7) | 4 (40.0) |
Patients with serious infections | 7 (1.4) | 4 (5.3) | 10 (1.8) | 1 (2.7) | 10 (1.7) | 1 (10.0) |
Through week 112 |
Mean duration of follow-up, weeks | 96.6 | 90.9 | 96.4 | 88.7 | 96.2 | 76.9 |
Mean number of golimumab infusions | 12.0 | 11.3 | 12.0 | 10.9 | 12.0 | 9.4 |
Patients with ≥ 1 AE | 417 (82.1) | 61 (80.3) | 445 (81.4) | 33 (89.2) | 468 (81.5) | 10 (100.0) |
Patients with infections | 262 (51.6) | 42 (55.3) | 279 (51.0) | 25 (67.6) | 297 (51.7) | 7 (70.0) |
Patients with ≥ 1 SAE | 90 (17.7) | 19 (25.0) | 97 (17.7) | 12 (32.4) | 102 (17.8) | 7 (70.0) |
Patients with serious infections | 27 (5.3) | 9 (11.8) | 32 (5.9) | 4 (10.8) | 34 (5.9) | 2 (20.0) |
The proportion of patients with at least one SAE through week 52 was numerically higher in patients ≥ 65 years (9/76, 11.8%) than in those aged < 65 years (45/508, 8.9%). Through week 52, the proportion of patients with at least one SAE was numerically higher for patients ≥ 70 years (5/37, 13.5%) compared with patients < 70 years (49/547, 9.0%) and for patients ≥ 75 years (4/10, 40.0%; cholecystitis and electrolyte imbalance [both in one patient], hemorrhoids, cerebral infarction, interstitial lung disease) compared with patients < 75 years (50/574, 8.7%). However, it should be noted that the numbers of patients ≥ 70 years and ≥ 75 years were relatively small. A similar trend was also observed for the proportions of patients with at least one AE through week 52.
Through week 112, 19 (25.0%) patients ≥ 65 years had an SAE, including cellulitis and bacterial arthritis. Among patients ≥ 75 years (n = 10), 7 (70.0%) had an SAE, including intervertebral discitis and diverticulosis. Ninety patients (17.7%) < 65 years had an SAE through week 112, including one patient with acute pancreatitis. Other SAEs through week 112 included fractures in eight golimumab plus MTX-treated patients: five who were < 65 years, one who was ≥ 65 and < 70 years (femoral neck fracture), one who was ≥ 70 and < 75 years (upper limb fracture), and one who was ≥ 75 years (spinal compression fracture; same patient with the intervertebral discitis). Additionally, among patients treated with golimumab plus MTX, six malignancies were reported through week 112; all occurred in patients < 65 years (breast cancer, cervical carcinoma stage 0, basal cell carcinoma (n = 2), Bowen’s disease, and chronic lymphocytic leukemia).
In the overall GO-FURTHER population, 36 golimumab plus MTX-treated patients (6.2%) experienced a serious infection through week 112 [
7]. In this post hoc analysis by age, there was a higher incidence of serious infections among patients ≥ 65 years, ≥ 70 years, and ≥ 75 years when compared with patients < 65 years, < 70 years, and < 75 years, respectively, through weeks 52 and 112; however, the numbers of patients ≥ 70 years and ≥ 75 years were small. Serious infections included sepsis (
n = 2), septic arthritis (
n = 1), and cellulitis (
n = 1) among patients ≥ 65 years and rectal abscess (
n = 1), sepsis (
n = 1), and urosepsis (
n = 1) among patients < 65 years. Two serious opportunistic infections were reported: infective spondylitis (
Candida albicans) in a patient ≥ 75 years and a serious infection of cryptococcal pneumonia in a patient ≥ 65 years from South Korea. Three cases of active tuberculosis were reported through week 112, all in patients younger than 65 years. Through week 112, seven patients experienced an SAE of pneumonia; all were younger than 65 years, with the exception of the patient with cryptococcal pneumonia. There was no predominant type of serious infection, including opportunistic infections, among patients ≥ 65 years. Among patients who did not use corticosteroids at baseline, the incidence of serious infections through week 112 was similar for patients < 65 years and ≥ 65 years (13/170, 7.6%, and 3/33, 9.1%, respectively), while among patients who received oral corticosteroids at baseline, the incidence of serious infections was numerically higher for patients ≥ 65 years (6/43, 14.0%) compared with those < 65 years (14/338, 4.1%).
A total of five deaths occurred through 2 years in patients who received golimumab plus MTX [
7,
18]: four occurred in patients who were younger than 65 years (myocardial infarction complicated by presumed pneumonia, abdominal tuberculosis, septic shock, and unknown causes) and one occurred in a patient older than 65 years (
Clostridium difficile). One death occurred in a patient receiving placebo plus MTX (< 65 years; presumed stroke secondary to hypertensive crisis) as previously reported [
18].