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Adalimumab (Humira)
Adalimumab, marketed under the brand name Humira, is a biologic medication and a tumor necrosis factor-alpha (TNF-α) inhibitor. It is widely used to treat autoimmune and inflammatory conditions such as rheumatoid arthritis, psoriasis, Crohn’s disease, and ulcerative colitis. This article synthesizes information from the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to provide a detailed overview of adalimumab, including its mechanism, uses, dosing, side effects, precautions, and drug interactions.
Adalimumab is a monoclonal antibody that binds specifically to TNF-α, a pro-inflammatory cytokine. By inhibiting TNF-α, adalimumab:
- Reduces inflammation: Prevents TNF-α from binding to its receptors, thereby decreasing the production of inflammatory mediators (Lippincott, Lange).
- Modulates the immune response: Suppresses the overactive immune system in autoimmune diseases, reducing tissue damage and symptoms (BNF).
Adalimumab is administered subcutaneously and has a half-life of approximately 10–20 days, allowing for biweekly dosing (Lippincott).
- Rheumatoid Arthritis (RA):
- Reduces joint inflammation and slows disease progression (BNF).
- Psoriasis and Psoriatic Arthritis:
- Improves skin lesions and joint symptoms (Lippincott).
- Crohn’s Disease and Ulcerative Colitis:
- Induces and maintains remission in inflammatory bowel disease (IBD) (Lange).
- Ankylosing Spondylitis:
- Reduces spinal inflammation and improves mobility (BNF).
- Juvenile Idiopathic Arthritis (JIA):
- Used in children aged 2 years and older (Lippincott).
- Adults:
- Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis: 40 mg subcutaneously every 2 weeks (BNF).
- Crohn’s Disease and Ulcerative Colitis: 160 mg initially, followed by 80 mg at week 2, then 40 mg every 2 weeks (Lippincott).
- Psoriasis: 80 mg initially, followed by 40 mg every 2 weeks starting 1 week after the initial dose (Lange).
- Children (≥2 years):
- Juvenile Idiopathic Arthritis: 24 mg/m² (max 40 mg) subcutaneously every 2 weeks (BNF).
Administration:
- Administer subcutaneously into the thigh or abdomen.
- Rotate injection sites to avoid skin reactions (Lippincott).
- Common: Injection site reactions, headache, and upper respiratory infections (Lippincott).
- Serious:
- Infections: Increased risk of bacterial, viral, and fungal infections, including tuberculosis (TB) and hepatitis B reactivation (Lange).
- Malignancies: Rare cases of lymphoma and other cancers (BNF).
- Heart Failure: Worsening of pre-existing heart failure (Lippincott).
- Infections: Screen for TB and hepatitis B before starting therapy. Avoid in active infections (BNF).
- Heart Failure: Use with caution in patients with moderate to severe heart failure (Lippincott).
- Pregnancy and Lactation: Use only if benefits outweigh risks; limited data available (Lange).
- Hypersensitivity: Contraindicated in patients with known hypersensitivity to adalimumab or its components (BNF).
- Live Vaccines: Avoid concurrent use due to risk of vaccine-induced infections (Lippincott).
- Other Immunosuppressants: Increased risk of infections when combined with drugs like methotrexate or corticosteroids (Lange).
- Anakinra or Abatacept: Increased risk of serious infections; avoid concurrent use (BNF).
Adalimumab is the generic name for this medication. It is marketed under the brand name Humira®. Biosimilar versions, such as Amgevita® and Hyrimoz®, are also available, providing cost-effective alternatives.
