Adalimumab

Adalimumab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and juvenile inflammatory arthritis (JIA). It is also used for psoriasis, Crohn’s disease, ulcerative colitis, hidradenitis suppurativa, uveitis, and other diseases.

For RA and PsA, adalimumab may be used as monotherapy or in combination with DMARD therapy, such as methotrexate (MTX).

For people recently diagnosed with RA, who have not been previously treated with MTX, adalimumab should be given in combination with MTX (unless MTX cannot be taken).

Adalimumab may be used as monotherapy for treatment of AS that has not responded to DMARD therapy.

Adalimumab is delivered by subcutaneous (s.c.) injection (meaning injection with a needle in the fatty layer of tissue just under the skin).

The usual dose of adalimumab is 40 mg given once every two weeks. In some cases, it may be given once a week.

The medication comes in a single-use pre-filled syringe or autoinjector for administration.

In some people with arthritis, a signalling protein called tumour necrosis factor (TNF) is present in the blood and joint in excessive amounts where it increases inflammation. Adalimumab works by suppressing the body’s immune system, specifically it binds to TNF and prevents it from causing inflammation. By doing this, adalimumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of the adalimumab right away. Some people begin to feel the effects of the medication after 2 weeks; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for adalimumab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Taking adalimumab can make it more difficult for your body to fight infections. Therefore, people with active infections should not take this medication. If you have a fever, think you may have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of adalimumab with their healthcare provider.

Also contact your healthcare provider if you are having surgery as you may need to stop adalimumab until you are healed and there is no sign of infection.

Adalimumab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made with your healthcare provider on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent. Breastfeeding/chestfeeding is not recommended for at least five months after the last adalimumab treatment.

Those who have had a previous allergic reaction to adalimumab should avoid the medication.

Anyone with a history of cancer or nervous system problems, such as multiple sclerosis, should discuss the use of adalimumab with their healthcare provider.

Adalimumab may make a condition called congestive heart failure worse. Tell your doctor if you have congestive heart failure.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because adalimumab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start adalimumab.

Ideally, your vaccinations should be up to date prior to starting adalimumab. If you have already started therapy with adalimumab, your healthcare provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking adalimumab, you should speak with your healthcare provider.

Like all medications, taking adalimumab carries some risk of side effects, which must be balanced with its potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from adalimumab. When monitored properly, the vast majority of side effects are rare, most improve over time and are reversible.

Adalimumab can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

In rare cases, adalimumab can cause a reaction (redness, pain, and itching) at the injection site. Talk to your healthcare provider if these symptoms become severe.

Another rare side effect people may experience while taking adalimumab is headaches. If this becomes severe, speak with your healthcare provider.

Some people have developed lupus-like symptoms that disappeared after the medication was stopped. If you have chest pains that do not go away, shortness of breath or a rash on your cheeks or arms that gets worse in the sun, call your doctor right away.

There have been unusual cases of disorders that affect the nervous system resulting from people taking adalimumab or other TNF-blockers. Signs that you could be experiencing a problem affecting your nervous system include numbness or tingling, problems with your vision, weakness in your legs and dizziness.

Adalimumab very rarely can cause a drop in blood counts.

Take adalimumab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

Those with smaller amounts of subcutaneous tissue can consider an adalimumab version that may be more concentrated and therefore requires a lower injection volume resulting in fewer injection site reactions.

Blood tests are not routinely required while you are taking adalimumab. However, your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Citrate is frequently added to parenteral drugs to enhance the stability of the product. It has been suggested that citrate may contribute to injection site pain during administration however, the evidence for this is still unclear. Many factors can be associated with injection site pain including the pH of the formulation, amount of drug injected, needle size and bevel, injection speed, fluid viscosity, and injection technique. The perception of pain is multifactorial and so it is difficult to say if an individual will experience more pain with one product over another.

There is no conclusive evidence available to routinely recommend a citrate-free version of adalimumab over a version containing citrate. Some experts recommend a citrate-free version for use in children which may help reduce injection pain and injection site reactions. Your doctor will work with you to select an appropriate drug product. If you have concerns about injection pain, talk with your doctor about things you can do to minimize the pain. Taking the time to learn and consistently use good injection technique can help you minimize any potential injection pain.

Adalimumab must be refrigerated at 2 to 8 degrees Celsius until you are ready to use it. Keep the product in the original package and out of the light. Once the product is warmed up to room temperature, it will have a shorted stability depending on the version of adalimumab you have, ranging from 14 to 28 days, and it cannot be put back into the fridge to extend its stability. 

Adalimumab must be kept cool while travelling to maintain its stability or can be stored at room temperature if it will be used in a short period of time, 14 to 28 days depending on the version of adalimumab. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.  

Each version of adalimumab has its own patient support program. These can be found in the list below. 

• Abrilada
  PSP: PfizerFlex (1-855-935-3539)
• Amgevita
  PSP: Enliven (1-877-936-2735) 
• Hadlima
  PSP: Harmony by Organon (1-866-556-5663) 
• Hulio
  PSP: Viatris Advocate (1-844-554-8546) 
• Humira
  PSP: Abbvie Care (1-866-848-6472) 
• Hyrimoz
  PSP: Xpose (1-888-449-7673) 
• Idacio
  PSP: KabiCare (1-888-304-2034)
• Simlandi
  PSP: JampCare (1-855-310-5102)
• Yuflyma
  PSP: Celltrion Connect (1-855-966-1948)