These variants are typically aggregates, deamidation products, glycosylation variants, oxidized amino acid side chains, as well as amino and carboxyl terminal amino acid additions.  These seemingly minute structural changes can affect preclinical stability and process optimization as well as therapeutic product potency, bioavailability and immunogenicity . The generally accepted purification method of process streams for monoclonal antibodies includes capture of the product target with protein A , elution, acidification to inactivate potential mammalian viruses, followed by ion chromatography , first with anion beads and then with cation beads. [ citation needed ]
Large, double-blind randomized controlled trials in patients with rheumatoid arthritis have shown that golimumab in combination with methotrexate was more effective than methotrexate alone.  When clinically indicated, golimumab is estimated as a moderate cost-effective treatment option. National Institutes for Health and Care Excellence (NICE) stated that treatment with golimumab is not recommended for RA patients who have failed prior TNFi treatment.  Unlike other TNFi treatments such as adalimumab and certolizumab pegol , there have been no reported cases of drug-induced lupus-like syndrome (DILS).