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.
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:
Adalimumab is also indicated for dermatological, gastrointestinal and ophthalmological indications:
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.
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.
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.
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.
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.
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.
Talk this over with your consultants. It is possible you will be advised to discontinue adalimumab for a period before and after surgery.
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.
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.
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.
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.