Adalimumab

 

What is Adalimumab?

Adalimumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints. Adalimumab works on the inflammatory pathway to inhibit proteins called tumour necrosis factors or TNF, reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

Adalimumab is known as an anti-TNF biological from its effects, there are other medications in this group such as infliximab or etanercept.

 

What is Adalimumab used for?

Adalimumab is used for the treatments of inflammatory diseases such as:

• Rheumatoid arthritis
• Psoriatic arthritis
• Axial spondyloarthritis such as ankylosing spondylitis

 

How is it taken?

Adalimumab is taken as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh. It is given at a dose of 40mg every 2 weeks.

The injection device is available as a pen or prefilled syringe. It should be stored in the fridge at home.

 

Adalimumab can be given alongside other DMARDs such as methotrexate, or taken on its own.

 

The injections can take up to 12 weeks to have an effect. When you first start taking it you will need your bloods checked after 3 months of taking it, you will then require bloods to be taken once a year. If you are on other medication, you must still attend for blood monitoring for them.

 

Side effects

There are a few possible side effects that can occur in a small number of people that take adalimumab, these include:

 

• Feeling sick, vomiting and headaches
  • These usually settle after taking the injections for a few weeks.
• Increased risk of infections
  • As adalimumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Injection site reactions
  • Irritation, rashes and blistering can occur.
  • Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
• Small increased risk of non-malignant skin cancer
  • Anti-TNF treatments have been associated with a small increased risk, you should try to reduce your risk by being safe in the sun and assessing your moles regularly.
• Drug induced lupus
  • Rarely adalimumab can cause a rash, joint pains and fevers. If this occurs it usually stops after stopping the injections.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact. You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the adalimumab is commenced.
• Adalimumab is not safe to be used if you are being investigated for or have been diagnosed with cancer.
• Adalimumab is not used if you or a close family member have been diagnosed with multiple sclerosis (MS)
• If you have severe lung and heart conditions, anti-TNF treatments may not be suitable.

Operations

• Adalimumab should be withheld for 3 weeks prior to surgery.

During pregnancy and breastfeeding

• Adalimumab is safe for use in pregnancy until the end of the second trimester.
• It is safe to take during breastfeeding.
• There is some evidence to suggest it is safe to be used by the male partner during conception.

Alcohol

• Alcohol and adalimumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking adalimumab.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org