Adalimumab for rheumatoid arthritis

Examples

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Brand Name	Generic Name
Humira	adalimumab

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

How It Works

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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 rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Why It Is Used

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Adalimumab has been approved for use in treating adults with moderate to severe rheumatoid arthritis. Adalimumab may be used alone or in combination with other DMARDs such as methotrexate.

How Well It Works

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Adalimumab appears to work rapidly and is well-tolerated. 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

Side Effects

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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

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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 health professional 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

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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.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	August 18, 2008