Adalimumab

Aka: Adalimumab, Humira, Abrilada, Amjevita, Cyltezo, Hulio, Hyrimoz, Yusimry

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II. Indications

  1. Severe active Rheumatoid Arthritis refractory to DMARDs
  2. Plaque Psoriasis
  3. Crohns Disease
  4. Hidradenitis Suppurativa

III. Contraindications

  1. See Tumor Necrosis Factor Inhibitor

IV. Mechanism

  1. See Tumor Necrosis Factor Inhibitor
  2. Monoclonal Antibody against human Tumor Necrosis Factor alpha
  3. Similar to Infliximab and Etanercept

V. Precautions

  1. See TNF Inhibitor
  2. TNF Inhibitors predispose to serious infections and malignancy
  3. Prepare for TNF Inhibitor use with infection screening (e.g. Tuberculosis) and Immunizations
    1. See Monoclonal Antibody

VI. Medications

  1. Humira (Adalimumab)
    1. Original prototype drug with release in 2003 for Rheumatoid Arthritis, with expanding indications since
  2. Multiple biosimilar agents pending release in 2023
    1. Abrilada (Adalimumab-afzb)
    2. Amjevita (Adalimumab-atto)
    3. Cyltezo
    4. Hulio
    5. Hyrimoz
    6. Yusimry

VII. Dosing

  1. See Monoclonal Antibody for preparation for use
  2. Background
    1. Injection sites include thigh or Abdomen
    2. Refrigerate and protect from light
    3. Stable at room Temperature for up to 14 days
    4. Allow to warm to room Temperature for 15 to 30 minutes before injection (decreased pain)
  3. General adult (and children weight >40 to 60 kg) dosing protocol
    1. Dosing protocols vary by indication and in children
    2. Active Disease (Induction)
      1. Start 160 mg SQ as a single dose (or split, given 80 mg on 2 consecutive days)
    3. Maintenance
      1. Every other week: 40 mg SQ

VIII. Adverse Effects

  1. See Tumor Necrosis Factor Inhibitor
  2. Immunosuppression
    1. Use caution in any patient prone to infection
  3. Headache
  4. Rash
  5. Injection site inflammation
  6. Gastrointestinal upset
  7. Other effects
    1. Hypertension
    2. Hyperlipidemia

IX. Safety

  1. Considered safe in Lactation
  2. Pregnancy
    1. First trimester use benefit outweighs risk if indicated
    2. Unknown safety after first trimester, but exposure risk increases after 20 weeks (monitored by registry)

X. Pharmacokinetics

  1. Metabolism by proteolysis

XI. Resources

  1. Adalimumab Injection Kit (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=608d4f0d-b19f-46d3-749a-7159aa5f933d

XII. References

  1. (2003) Lexi-Comp Drug Database
  2. (2023) Biologics for Crohn's Disease, Presc Lett, #390826
  3. (2023) Drugs for Inflammatory Bowel Disease, Med Lett Drug Ther 65: 105-12

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