Golimumab is recommended, within its marketing authorisation, as an option for treating active non-radiographic axial spondyloarthritis in adults if:
the condition has a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of 4 units or more and a spinal visual analogue scale (VAS) of 4 cm or more
nonsteroidal anti-inflammatory drugs have not controlled the condition well enough or are not tolerated.
If patients and their clinicians consider golimumab to be one of a range of suitable treatments, including adalimumab, etanercept and certolizumab pegol, the least expensive (taking into account administration costs and patient access schemes) should be chosen.
Assess the response to golimumab 12 weeks after the start of treatment. Continue treatment only if there is clear evidence of response, defined as:
a reduction in the BASDAI score to 50% of the pre-treatment value or by 2 or more units and
a reduction in the spinal pain VAS score by 2 cm or more.
When using BASDAI and spinal pain VAS scores, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the questionnaires, and make any adjustments they consider appropriate.
Why the committee made these recommendations
NICE already recommends adalimumab, etanercept and certolizumab pegol for treating non-radiographic axial spondyloarthritis. An indirect comparison shows that golimumab provides similar overall health benefits to these drugs. The acquisition costs of golimumab are the same as or less than those of adalimumab and etanercept, and in the longer term, would be similar to those of certolizumab pegol.
Because it is has similar overall health benefits and costs to adalimumab, etanercept and certolizumab pegol, golimumab is recommended for treating non-radiographic axial spondyloarthritis in the NHS.