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Adalimumab: Uses, Mechanism & Side Effects

Adalimumab is a biologic medication used to treat chronic inflammatory conditions such as rheumatoid arthritis, Crohn's disease, and psoriasis.

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Things worth knowing about "Adalimumab"

Adalimumab is a biologic medication used to treat chronic inflammatory conditions such as rheumatoid arthritis, Crohn's disease, and psoriasis.

What is Adalimumab?

Adalimumab is a fully human monoclonal antibody that targets tumor necrosis factor alpha (TNF-α), a key signaling molecule of the immune system. TNF-α plays a central role in driving inflammation in a range of chronic inflammatory diseases. Adalimumab belongs to the class of medicines known as biologics and is marketed under the brand name Humira, as well as several approved biosimilar products.

Mechanism of Action

Adalimumab works by binding specifically and with high affinity to both soluble and membrane-bound TNF-α. By neutralizing TNF-α, it prevents this molecule from binding to its receptors on cell surfaces and triggering inflammation-promoting signaling cascades. This leads to a significant reduction in inflammatory processes throughout the body.

Inhibition of TNF-α-mediated inflammatory response
Reduction in the release of pro-inflammatory cytokines
Decreased migration of immune cells into inflamed tissue
Protection of joints and tissues from structural damage

Indications (Approved Uses)

Adalimumab is approved for a wide range of chronic inflammatory conditions, including:

Rheumatoid arthritis (inflammatory joint disease)
Psoriatic arthritis (psoriasis with joint involvement)
Ankylosing spondylitis (inflammatory spinal disease)
Crohn's disease (chronic inflammatory bowel disease)
Ulcerative colitis (inflammatory disease of the large intestine)
Plaque psoriasis (chronic skin condition)
Uveitis (inflammation of the middle layer of the eye)
Hidradenitis suppurativa (chronic inflammatory skin condition)
Juvenile idiopathic arthritis (in children and adolescents)

Dosage and Administration

Adalimumab is administered as a subcutaneous injection, meaning it is injected just under the skin, typically in the abdomen or thigh. It is available as a pre-filled syringe or autoinjector pen, and can be self-administered at home after appropriate training.

Dosing intervals vary depending on the condition being treated:

For most adult indications: 40 mg every two weeks
For some indications, weekly dosing of 40 mg may be required
In children, dosing is based on body weight and the specific condition

Side Effects

Like all medicines, adalimumab can cause side effects. The most common include:

Injection site reactions (redness, swelling, pain)
Increased susceptibility to infections, especially respiratory infections
Headache and dizziness
Elevated liver enzyme levels
Skin rash

Less common but serious side effects may include:

Serious infections (e.g., tuberculosis, opportunistic infections)
Reactivation of latent tuberculosis
Demyelinating disorders (damage to nerve sheaths)
Worsening of pre-existing heart failure
Lymphoma and other malignancies (rare)

Contraindications

Adalimumab must not be used in patients with:

Active severe infections, including active tuberculosis
Moderate to severe heart failure
Known hypersensitivity to adalimumab or any of its excipients

Important Considerations Before and During Treatment

Before starting adalimumab therapy, patients must be tested for latent tuberculosis, as inhibition of TNF-α can promote its reactivation. Regular monitoring by a healthcare professional is required throughout treatment. Live vaccines should not be administered during therapy with adalimumab.

Adalimumab Biosimilars

Following the expiry of the patent for the original product Humira, several biosimilars (biologically similar follow-on medicines) have become available on the market. These biosimilars have demonstrated comparable efficacy and a similar safety profile to the original product, and are subject to rigorous evaluation by regulatory authorities.

References

European Medicines Agency (EMA): Humira - European Public Assessment Report (EPAR). Available at: https://www.ema.europa.eu
Smolen JS et al. - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of the Rheumatic Diseases, 2020.
Summary of Product Characteristics - Humira (Adalimumab), AbbVie, current version.

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