Adalimumab

Examples

Generic Name Brand Name
adalimumab Humira

Adalimumab is given as a shot under the skin (subcutaneous injection).

How It Works

Adalimumab reduces the effects of tumor necrosis factor (TNF). TNF is produced in your body in times of inflammation and attaches to the joint surface, causing damage to soft tissues, cartilage, and bones. Adalimumab is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of conditions such as rheumatoid arthritis and ankylosing spondylitis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Why It Is Used

Adalimumab is used to treat adults who have inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis. Adalimumab may be used alone or in combination with other DMARDs such as methotrexate.

How Well It Works

Adalimumab appears to work rapidly and is well tolerated.

Rheumatoid arthritis. A clinical trial of adalimumab used in combination with methotrexate found a 20% improvement in 67% of people who were given the medicine, with improvements noticeable after 1 week of treatment.1 In another study of adalimumab used alone, researchers report significant, rapid, sustained reductions in disease activity and improved physical function, including reduced swelling and pain.2

Ankylosing spondylitis. Studies show that adalimumab decreases disease activity and symptoms, and it increases quality of life.3, 4

Side Effects

The most common side effect of TNF antagonists, such as adalimumab, is an allergic reaction to the injection (shot). If you have a reaction to the shot, it will happen right away, either during the shot or within 1 to 2 hours after the shot. Your doctor may give you medicines to prevent or stop the reaction.

Symptoms of a reaction to the shot include:

  • Fever.
  • Chills.
  • Chest pain.
  • Shortness of breath.
  • Itching (pruritus).
  • Headache.
  • Nausea.
  • Heat and redness (flushing) in the face.
  • Rash.
  • Fatigue.
  • Dizziness.

Warnings about serious side effects of TNF antagonists have been issued. The U.S. Food and Drug Administration (FDA) and the drug’s manufacturers have warned about:

  • An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
  • An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
  • A possible increased risk of lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk. There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking TNF antagonists, that often results in death.
  • An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever or dark brown urine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Adalimumab is significantly more expensive than DMARDs such as methotrexate and sulfasalazine.

Adalimumab should not be used by pregnant women or women of childbearing age who are not using reliable birth control. If you are going to take adalimumab, you should be on some form of reliable birth control. If you plan to become pregnant, check with your doctor before stopping birth control and trying to become pregnant.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Weinblatt ME, et al. (2003). Adalimumab, a fully human anti-tumor necrosis factor-a monoclonal antibody alpha for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate. Arthritis and Rheumatism, 48(1): 35–45.
  2. Van de Putte LBA, et al. (2004). Efficacy and safety of adalimumab as monotherapy in patients with rheumatoid arthritis for whom previous disease modifying antirheumatic drug treatment has failed. Annals of the Rheumatic Diseases, 63(5): 508–516.
  3. Van er Heijde D, et al. (2006). Efficacy and safety of adalimumab in patients with ankylosing spondylitis. Arthritis and Rheumatism, 54(7): 2136–2146.
  4. Davis JC, et al. (2007). Health-related quality of life outcomes in patients with active ankylosing spondylitis treated with adalimumab: Results from a randomized controlled study. Arthritis and Rheumatism, 57(6): 1050–1057.

Last Updated: August 18, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology

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