Alhalabi MM, Abbas AJ. Subcutaneous golimumab to treat a biological naïve chronically active ulcerative colitis child. A case report.
Ann Med Surg (Lond) 2022;
75:103456. [PMID:
35386809 PMCID:
PMC8977938 DOI:
10.1016/j.amsu.2022.103456]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction
Ulcerative colitis is an immune-mediated disease that carries challenges in pediatrics since it's frequently severe and extensive. Current pediatric ulcerative colitis guidelines offer a weak recommendation regarding the usage and the dosage of golimumab in low-weight children. We present a case of an off-label, unrecommended dose of subcutaneous golimumab to treat low-weight chronic active ulcerative colitis child.
Case presentation
A 10-year-old Syrian girl, anti-TNF naïve, chronically active ulcerative colitis was weighs 25 kg, standing 142 cm tall, body surface area (BSA) of 0.993 m2, past medications included oral prednisone and mesalamine, no prior surgery. We used golimumab 200 mg, 100 mg at weeks 0, 2 as induction, then 50 mg every four weeks for about two years.
Clinical discussion
The recommendation regarding the use of subcutaneous golimumab in pediatrics is weak since is based on an open-label pharmacokinetics cohort. It is available in 100 mg/1 ml, 50 mg/0.5 ml as a smart SmartJect, or in 45 mg/0.45 ml in VarioJect which provides golimumab from 10 mg to 45 mg in increments of 5 mg/0.05 ml. Golimumab Varioject is in short supply, and unavailable in several regions including Syria. The recommended golimumab maintenance dose always requires two injectors, which adds another burden.
Conclusion
This case demonstrated that golimumab 200 mg, 100 mg at week 0, 2 as an induction then 50 mg every four weeks was efficacious and safe in<45 kg children, there were no side effects or adverse events during two years therapy period.
Golimumab,a human IgG1 TNFα antagonist that may be the first biological treatment choice in both naive and biological expert active chronic pediatric ulcerative colitis.
Subcutaneous golimumab at doses of 200 mg 100 mg at week 0, 2, then 50 mg every four weeks is both safe and effective in the treatment of low-weight active chronic pediatric ulcerative colitis.
The 60 mg SC golimumab maintenance will require two injectors, at least one of them varioject which is in short supply.
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