What is golimumab?
Golimumab is a biologic medication available in two forms: Simponi (subcutaneous injection) and Simponi Aria (intravenous infusion). It is used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. Its key advantage is convenient dosing — once monthly for the subcutaneous form, or once every 8 weeks for the IV form.
How it works
Golimumab is a TNF inhibitor. It targets tumor necrosis factor-alpha (TNF-alpha), a protein that your immune system overproduces in autoimmune conditions. Excess TNF-alpha drives the inflammation behind joint pain, swelling, stiffness, and tissue damage.
Golimumab is a fully human monoclonal antibody — it binds directly to TNF-alpha and prevents it from triggering inflammatory pathways. By neutralizing excess TNF, it helps bring your overactive immune system back toward balance.
How it’s given
Golimumab comes in two formulations with different dosing schedules:
Simponi (subcutaneous):
- 50 mg injection once per month
- Self-administered at home using a prefilled syringe or SmartJect autoinjector
- Store in the refrigerator — remove and let it warm to room temperature for approximately 30 minutes before injecting
- Rotate injection sites between the thigh and abdomen (at least 2 inches from the navel)
Simponi Aria (intravenous):
- Weight-based infusion given at weeks 0 and 4, then every 8 weeks thereafter
- Administered in our infusion center over approximately 30 minutes
- You will be monitored during and briefly after each infusion
Your doctor will determine which form is best for you based on your condition, insurance coverage, and lifestyle preferences.
What to expect when starting
Improvement typically begins within 2–4 weeks, with the full effect usually reached by 3 months. The once-monthly (subQ) or once-every-8-weeks (IV) schedule means fewer doses to keep track of compared to other TNF inhibitors.
For rheumatoid arthritis, golimumab should be used with methotrexate. The combination is more effective and helps prevent your body from developing antibodies against the drug.
Side effects to watch for
Common:
- Injection site reactions (Simponi subQ) — redness, itching, or swelling at the injection site. Usually mild and temporary.
- Infusion reactions (Simponi Aria IV) — may include headache, mild fever, or flushing during or shortly after the infusion. Our infusion staff monitors you closely for these.
Important — contact us if you experience:
- Fever, chills, or any signs of infection (sore throat, cough, burning with urination, a wound that isn’t healing)
- Unusual fatigue or feeling persistently unwell
- New numbness, tingling, or vision changes (very rare neurological side effect)
- New or worsening heart failure symptoms (shortness of breath, leg swelling)
Important: Like all TNF inhibitors, golimumab reduces part of your immune defense. Infections should be taken seriously — contact us early rather than waiting to see if symptoms resolve on their own.
Required screening before starting
Before your first dose, we will check:
- TB screening (QuantiFERON blood test or PPD skin test) — TNF inhibitors can reactivate latent tuberculosis
- Hepatitis B screening — TNF inhibitors can reactivate dormant hepatitis B infection
- Baseline blood work including CBC and metabolic panel
- Review of your vaccination history — certain vaccines should be given before starting
Things to avoid
- Live vaccines — including live shingles vaccine (Zostavax), live nasal flu spray, and MMR. Inactivated vaccines (flu shot, COVID, Shingrix) are safe and recommended. Talk to us before any vaccination.
- Other biologics — golimumab should not be taken with another biologic medication. Combining biologics significantly increases infection risk without meaningful added benefit.
- Don’t ignore infections — contact us if you develop fever, chills, or any signs of infection. We may advise holding a dose until the infection clears.
Frequently asked questions
What’s the advantage of golimumab over other TNF inhibitors? The main advantage is dosing convenience. Simponi (subQ) is once per month instead of weekly or every-two-weeks, and Simponi Aria (IV) is once every 8 weeks after the initial loading doses. If you prefer fewer injections or if infusion center visits are convenient for you, golimumab may be a great fit.
Which form is better — the injection or the infusion? Neither is medically superior. It comes down to personal preference and insurance coverage. Some patients prefer the independence of self-injection at home. Others prefer having the infusion administered by a nurse in a supervised setting. We’ll help you decide.
Do I have to take methotrexate with golimumab? For rheumatoid arthritis, yes — golimumab is recommended to be used in combination with methotrexate. For psoriatic arthritis and ankylosing spondylitis, methotrexate is not required but may still be used.
What if I miss a dose? For Simponi subQ, take the injection as soon as you remember, then resume your monthly schedule. For Simponi Aria IV, contact our office to reschedule your infusion as soon as possible.
Can I take golimumab during pregnancy? TNF inhibitors are generally considered low risk in pregnancy, especially during the first two trimesters. However, always discuss family planning with your rheumatologist before becoming pregnant so we can plan the safest approach. If pregnancy is a near-term consideration, your doctor may discuss certolizumab (Cimzia) as an alternative with even stronger pregnancy safety data.
Are there rare but serious risks I should know about? Like all TNF inhibitors, golimumab carries rare risks including reactivation of latent TB or hepatitis B (which is why we screen before starting), very rare cases of demyelinating disease, and a theoretical small increase in lymphoma risk — though the background rate of lymphoma is already elevated in patients with active inflammatory disease. These risks are uncommon, and for most patients the benefits of disease control far outweigh them.
This handout is for informational purposes and does not replace the advice of your physician. Always follow the specific instructions given to you by your rheumatologist. If you have questions or concerns about your medication, contact Synergy Rheumatology & Wellness.