What is Adalimumab?

Why is Adalimumab prescribed?

What are the possible side effects?

What are the risks?

What else should I know about Adalimumab?

What is Adalimumab?

Adalimumab (trade name Humira) is a an anti-TNF (anti-tumour necrosis factor) drug. In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is overproduced in the body, causing inflammation and damage to the joints. Anti-TNF drugs block the action of TNF and so reduce this inflammation.

What type of drug is adalimumab?

Adalimumab is type of drug known as a biologic therapy, its an anti-TNF (anti-tumour necrosis factor) drug.

What does it do?

Anti-TNF drugs block the action of TNF proteins and so reduce inflammation.

What is it used for?

It is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for children with juvenile idiopathic arthritis (JIA). 

How is it taken?

It is usually given as an injection under the skin (subcutaneous injection) once every two weeks.

Are there any side-effects?

The most common side-effects are reactions at the injection site, such as redness, swelling or pain. It can also make you more likely to develop infections.

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Why is Adalimumab prescribed?

Adalimumab is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for young people with juvenile idiopathic arthritis (JIA).

Adalimumab will only be prescribed if your arthritis is active. It will usually be used if you have already tried methotrexate or another disease-modifying anti-rheumatic drug (DMARD) such as sulfasalazine or hydroxychloroquine, or if you cannot use these drugs for any reason.

Slightly different restrictions may apply in the case of the other medical conditions, so you should discuss this with your doctor or rheumatology nurse.

Adalimumab was originally only available under the brand name Humira. But newer versions of biological therapies are becoming available, so you may be prescribed adalimumab under a different name, such as Amgevita, Hulio, Hyrimoz or Imraldi. These drugs are known as biosimilars and work in a similar way.

Don’t take over the counter preparations or herbal remedies without discussing this first with your doctor or pharmacist as some of them could react badly with adalimumab

Is there any reason I will not be prescribed adalimumab?

Adalimumab will not be prescribed if:

  • your rheumatoid arthritis is not active
  • you have an active infection.

Your doctor may decide not to prescribe adalimumab if you have a higher risk of problems, for example if:

  • you have had tuberculosis (TB) in the past
  • you have had other repeated infections
  • you have multiple sclerosis (MS)
  • you have had cancer
  • you have or have had heart failure
  • you have lung fibrosis (thickening of lung tissue)
  • you are pregnant or breastfeeding.

When and how do I take adalimumab?

Adalimumab is only available on prescription from a consultant rheumatologist, it usually given by an injection under the skin (subcutaneous injection) once every two weeks. Because it’s a long-term treatment, it’s important to keep taking adalimumab (unless you have severe side effects):

  • even if it doesn’t seem to be working at first
  • even when your symptoms improve, as this will help to keep your condition under control.

You, your partner, or another member of your family can learn to give the injections.

How long does adalimumab take to work?

If you respond to adalimumab you will probably feel better in 2–12 weeks.

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What are the possible side effects?

The most common side-effects are reactions at the injection site, such as redness, swelling or pain. These reactions are not usually serious.

Adalimumab has effects on the immune system (the body’s own defence system), and so you may be more likely to develop infections. At the same time, adalimumab can mask the symptoms of infection so you do not feel as ill as you normally would when you have an infection.

You should tell your doctor or rheumatology nurse straight away if you develop any of the following after starting adalimumab:

  • a sore throat
  • a fever
  • any other symptoms of infection
  • any other new symptoms or anything else that concerns you.

What should I look out for?

You should stop adalimumab and see your doctor immediately if:

  • any of the symptoms listed above persist or worry you
  • you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
  • you develop chickenpox or shingles.

Chickenpox and shingles can be severe in people on treatments that affect the immune system such as adalimumab. You may need antiviral treatment, which your doctor will be able to prescribe. Your adalimumab will be stopped if you do develop chickenpox or shingles and restarted when you are better.

Rarely, people may experience an allergic reaction to adalimumab. If the reaction is severe the drug will have to be stopped.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

Anti TNF drugs have been associated with some types of skin cancer. But the link between the two is unclear and skin cancers are usually treated successfully when diagnosed early. To be on the safe side, make sure to wear sunscreen and regularly check your skin for any new spots or changes to your freckles or moles. Please discuss this with your doctor or rheumatologist if you are worried.

Very rarely, people taking adalimumab may develop a condition called drug-induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, the adalimumab will be stopped and the condition then usually disappears.

How can I reduce the risk of infection?

Because of its effects on the immune system, adalimumab may make you more likely to pick up infections. You should try to avoid close contact with people with severe active infections, and visit the Food Safety Authority of Ireland website www.fsai.ie for information on reducing your risk of infection from foods.

Will it affect vaccinations?

If you are taking adalimumab it is recommended that you avoid live vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you.

If you are in your 70s and are offered shingles vaccination (Zostavax) your doctor may advise you to have this before starting adalimumab. Shingles vaccination is not recommended for people who are already on adalimumab.

If possible, children should be brought up to date with their immunisations before starting adalimumab therapy. Alternatively, children who require measles, mumps and rubella (MMR) immunisation may need to defer this while having treatment with adalimumab.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines do not interact with adalimumab and are recommended.

Can I drink alcohol while on adalimumab?

You can drink alcohol while on adalimumab but should not exceed recommended amounts (1–2 units per day for women and 2–3 units per day for men). If you have psoriasis and you are also taking methotrexate, your doctor may advise lower limits (no more than 4 units per week) because methotrexate and alcohol can interact and damage your liver. Alcohol can also worsen psoriasis.

Does adalimumab affect fertility or pregnancy?

If you are thinking of having a baby or if you become pregnant, you should discuss this with your rheumatologist. At present there is limited information on the use of adalimumab during pregnancy and on how it might affect an unborn baby. Similarly, the effects of adalimumab on men trying to father a child are uncertain.

Generally, it is recommended that men and women use contraception while on this drug. However, some women have used adalimumab successfully during pregnancy and guidelines may change as more evidence becomes available.

There may be an increased risk of infections in babies born to mothers using adalimumab, particularly if it is taken during the third trimester of pregnancy. If this medication is required in the third trimester, you will be advised to delay the live vaccination schedule for your baby until they are 7 months old.

If you are also taking methotrexate this drug should be stopped three months before you try for a baby.

Does it affect breastfeeding?

Generally, it is recommended that you do not breastfeed if you want to re-start adalimumab after pregnancy. However, limited information has shown that only small amounts of adalimumab may pass into your breast milk, so you should discuss with your doctor whether to take adalimumab whilst breastfeeding.

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What else should I know about Adalimumab?

If you are being prescribed adalimumab it is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse specialist. Then if you become unwell, anyone treating you will know that you are on adalimumab and that you are therefore at risk of its side-effects, including infections.

Are there any alternatives?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor or rheumatology nurse will discuss these other options with you.

Will I need any special checks while on adalimumab?

Before you start adalimumab you will have a chest x-ray and blood tests and a screening to check whether you have ever been exposed to tuberculosis (TB) or hepatitis. Some patients may need a course of treatment for latent (asymptomatic) TB before starting adalimumab. You may have further blood tests while you are on adalimumab to monitor its effects.

Adalimumab may increase the risk of the hepatitis B infection being reactivated in people who carry the virus. If your doctor decides that you may be at risk from a previous hepatitis B infection, they may test your blood for the presence of hepatitis B.

Can I take other medicines alongside adalimumab?

Adalimumab may be prescribed along with other drugs, including methotrexate. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are on adalimumab.

You should also be aware of the following points:

  • Adalimumab is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as adalimumab, unless your doctor advises otherwise. If adalimumab works for you, you may be able to reduce your NSAIDS or painkillers after a time.
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

Can I continue with adalimumab if I am going to have an operation?

If you are going to have an operation, please inform your doctor or specialist nurse, as you may be advised to stop the adalimumab temporarily before and after surgery.

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