Adalumimab (Humira, Exemptia)

Adalimumab is a TNF inhibitor, which blocks the cytokine TNF alfa; that mediates IBD in the intestine. In arthritis, it is a biological disease modifying antirheumatic drug (biological DMARDs or bDMARDs). The effect of the drug will be seen in the first 8 weeks of using the medication, but if you do not have the desires effect by the 12 or 16 weeks, it could be discontinued.

 However, if you miss the scheduled dose you may not get the desired effect. It is better not to switch a brand of the adalumimab (also not use a Biosimilar) unless your treating doctor knows about this.

Blood tests are needed during your treatment to watch for side effects and decide if the
treatment is working. How often you have blood tests will depend on what other medicines you are taking and what other illnesses you might have.

How is adalimumab taken?

Adalimumab should normally be kept refrigerated. If needed, for example when travelling, it may be stored below 25°C for up to 2 weeks and then used or discarded. Adalimumab come as a pre filled syringe, and is injected under the skin of the abdomen or thigh. It can be injected by your doctor, nurse, carer or by you. Typically, the site of injection is rotated every time, so as not to inject at the same site.

What is the dosage?

The usual dose for adults is 80 mg as the first dose, followed by 40mg once every two weeks. in case your doctor feels he needs the response earlier, he may advise you 160 mg as the first dose, followed by 80 mg 2 weeks later. The maintenance dose will remain 40 mg every 2 weeks.

Tests done before using Adalumimab:

Using Adalumimab may worsen the following conditions thus tests are done to rule them out.

  • Infections
    If you have a current infection of any kind treatment with adalimumab should not be given until the infection is treated. You will need some blood tests and a chest X-Ray to exclude some chronic infections before using Adalumimab.
  • Non infectious diseases:
    multiple sclerosis
    • moderate to severe heart failure.
    • systemic lupus erythematosus (lupus/SLE)

Most common possible side effects

  • Mild pain, swelling or itching at the site of the injection are very common (up to 20% of patients) but can be reduced by applying ice and antihistamine/steroid creams to the injection site and/or leaving the medicine out of the refrigerator for 30 minutes before
  • Headaches, cough, stomach and bowel discomfort may also occur.
  • As adalimumab affects the immune system, mild infections, mainly the upper respiratory tract (e.g. colds, sinusitis) may occur more often. Treatment with adalimumab may need to be briefly stopped for a serious infection.

Less common or rare possible side effects

  • A flare of tuberculosis, in case it has been missed at pre drug screening.
  • Rarely, adalimumab may cause an allergic reaction with itchy, red skin, a rash or a feeling
    of tightness in the chest and trouble breathing.
  • Side effects involving the nerves, such as inflammation of the nerve to the eye (Optic neuritis), may also occur rarely, causing changes in vision or sensation.
  • Very rarely ‘drug-induced lupus’ has occurred with symptoms of rash, fever and increased joint pain.
  • There is a suspicion that there may be an increase in the incidence of skin cancer, thus screening is advised.

Surgery while on Adalumimab: Adalimumab should be stopped before surgery, and resumed after the wound healing is complete.

Use with alcohol: You may drink alcohol while taking adalimumab. If you are also taking methotrexate you should be cautious about how much alcohol you drink.

Use in pregnancy and when breastfeeding: It is important to discuss with your doctor if you are planning a pregnancy while on adalimumab. It could be used by men trying to father a child. It may be used in pregnancy but if needed beyond 4 months of pregnancy it may increase the risk of infection in the newborn when live vaccines may be due. Therefore, vaccines such as Rotavirus should not be given before the baby is 6 months old. MMR may be given at 6 months.

There is only limited information regarding adalimumab in breast milk and while small amounts may occur, it does not seem to be harmful.

Concurrent Vaccination: you may not take ‘live’ vaccines such as:

  • MMR (measles, mumps and rubella),
  • Varicella vaccines (Chicken pox/Shingles),
  • OPV (oral polio virus),
  • BCG (Bacillus Calmette Guerin),
  • Japanese Encephalitis or
  • Yellow Fever.

Pneumococcal vaccines and the yearly seasonal flu vaccinations can be taken while on Adalumimab.