• Adalimumab

    There is overproduction of TNF (tumor necrosis factor) protein in rheumatoid arthritis (RA) and some other conditions, causing inflammation, pain and damage to the joints and bones. Anti-TNF drugs such as adalimumab blocks the action of TNF and so reduces the inflammation.

  • How Adalimumab is used?

    Adalimumab doesn’t act as a painkiller but it can modify the disease and improves the symptoms over a period of 2–12 weeks. Adalimumab can be prescribed by a consultant rheumatologist for following indications:

    • Rheumatoid Arthritis
    • Psoriatic Arthritis
    • Ankylosing Spondylitis
    • Juvenile Idiopathic Arthritis (JIA)

    Adalimumab is also indicated for dermatological, gastrointestinal and ophthalmological indications:

    • Hidradenitis Suppurativa
    • Plaque Psoriasis
    • Crohn’s Disease
    • Ulcerative Colitis
    • Uveitis

    There are various guidelines stating appropriate time of its use, and these may vary according to your medical and clinical condition. It is often prescribed along with a disease-modifying anti-rheumatic drug (DMARDS) such as methotrexate.

  • Adalimumab should not be started if

    • The disease is not active
    • You have any infection
    • You have not tried the first line treatment for the existing condition
  • Your doctor may not put you on adalimumab therapy if you have had

    • Frequent or severe infections
    • Multiple sclerosis (MS)
    • Cancer
    • A serious heart disease
    • Lung fibrosis

    Before starting adalimumab you may be asked to have a chest x-ray and tests to check if you have ever been exposed to tuberculosis (TB). You may require treatment for latent (asymptomatic) TB before starting adalimumab. You will also be examined for previous hepatitis infection, as adalimumab may increase the risk of hepatitis being reactivated. Further blood tests may require while you’re on Adalimumab to monitor its effects.

  • When and how to take adalimumab?

    The usual dose of adalimumab is 40 mg once every other week, given by subcutaneous injection (under the skin). You and your family member can learn to give the injections at home. Since it is a long-term treatment, it is important to keep taking adalimumab as recommended by your doctor.

  • Possible risks and side-effects of adalimumab

    • The most common side-effects are reactions at the injection site, for example swelling, redness or pain, but these are not usually serious. Rotating the injection site will help reduce the chances of this irritation
    • Because adalimumab involves the immune system, it can make you more likely to get infected and can make them harder to spot. Tell your consulting doctor if you develop any signs of infection – e.g. a sore throat, fever, diarrhoea, coughing up green phlegm – or any other different symptoms that concern you. If any of these symptoms get worsens, you should discontinue taking adalimumab and see your doctor straight away. Developing chickenpox or shingles; or if you come into contact with person who has chickenpox or shingles, may warn you to see your doctor immediately. These illnesses can become more severe if you are on adalimumab. You may require antiviral treatment, and your adalimumab may be discontinued until you are better. Rarely, people may develop some allergic reaction
    • Anti-TNF drugs have been related with some types of skin cancer – these can be promptly treated when diagnosed early. Research so far has not confirmed an increased risk of other cancers
    • Very rarely, adalimumab may cause drug-induced lupus, which can be diagnosed by a laboratory blood test. Symptoms comprise of a rash, fever and increased joint pain. Contact your doctor if you develop these symptoms. This condition is usually mild and clears up if adalimumab is stopped
  • How you can reduce the risk of infection

    • Always try to avoid close contact with individuals with severe active infections
    • You can use face masks when travelling outside
  • Taking other medications

    Adalimumab may be recommended along with other drugs, including methotrexate. Check with your doctor before beginning any new medications, and remember to tell that you are on adalimumab.

    • You can continue taking non-steroidal anti-inflammatory drugs (NSAIDs) or other painkillers if necessary, unless your doctor advises otherwise
    • Do not take over-the-counter preparations or herbal therapies without discussing it first with your healthcare team

    It is recommended that you carry a biological therapy alert card or a copy of current prescription so anyone treating you will know that you are on adalimumab. You can get these from your rheumatology department.

  • Vaccinations

    It is advised to discuss vaccinations with your healthcare team before starting adalimumab. It is usually suggested that people on adalimumab avoid live vaccines such.

    Inactive Pneumococcal vaccine (that gives protection against the commonest cause of pneumonia) and influenza vaccines are safe and recommended.

  • Having a surgery

    Talk this over with your consultants. It is possible you will be advised to discontinue adalimumab for a period before and after surgery.

  • Alcohol

    There is no well-known interaction between adalimumab and alcohol. However, if you are also taking methotrexate, it recommended limiting the alcohol intake of no more than 14 units of alcohol per week for adults because methotrexate and alcohol can interact and affect your liver. Your doctor may advise even lower limits.

  • Fertility and pregnancy

    • If you are planning to conceive, if you become pregnant, or if you are thinking of breastfeeding, it is suggested to discuss your medications with your rheumatologist
    • Guidelines suggest that adalimumab can be used during pregnancy and in men trying to father a child. While used during pregnancy it will generally be stopped after second trimester. If it is used after this, then it is possible (and yet not proven) that it may raise the risk of infection in the newborn baby
    • However, if there is concern that your arthritis may flare up if adalimumab is stopped then you may advised to continue with it throughout your pregnancy – in this case, your baby should not have any live vaccines (such as BCG) until they are seven months old
    • Women taking methotrexate should stop taking it and use contraception for at least three months before conceiving. As per guidelines there is no need for men to stop methotrexate when trying to father a baby
  • Breastfeeding or lactation

    Breastfeeding is not recommended if you are on adalimumab. The drug may pass into the breast milk and there is less or no evidence that how this might affect your baby. Small amounts of adalimumab may pass into the breast milk, but this does not appear to be unsafe. If you were on methotrexate therapy before your pregnancy this can be continued after you stop breastfeeding.

  • Additional information while using adalimumab

    If you are being prescribed adalimumab it is suggested that you carry a biological therapy alert card, which you can get from your consulting doctor or department. So if you become unwell, anyone treating you will come to know that you are on adalimumab and that you are therefore at risk of increased chances of infections.

  • Preliminary checks while starting adalimumab

    Before you starting adalimumab you will have a chest x-ray and blood tests. A screening is also required to check whether you have ever been exposed to tuberculosis (TB) or hepatitis. Some patients may require a course of treatment for latent (also called asymptomatic) TB before starting adalimumab. You may have further blood tests while you are on adalimumab to observe its effects. Adalimumab may raise the risk of the hepatitis B infection being reactivated in individuals who carry the virus. If your doctor finds that you may be at risk from a earlier hepatitis B infection, they may test your blood for the existence of hepatitis B.

  • References