Adalimumab (brand name Humira) is a type of drug known as
anti-TNF (anti-tumour necrosis factor). In people with rheumatoid
arthritis and some other inflammatory diseases a protein called TNF
is overproduced in the body, causing inflammation and damage to
bones, cartilage and tissue. Anti-TNF drugs block the action of TNF
and so can reduce this inflammation.
Why is adalimumab prescribed?
Adalimumab is available for people
with rheumatoid arthritis, psoriatic arthritis and ankylosing
spondylitis, and for children with juvenile idiopathic arthritis
(also known as JIA or JCA).
Adalimumab will only be prescribed if
your arthritis is active. If you have rheumatoid arthritis it will
only be used if you have already tried methotrexate and another
disease-modifying anti-inflammatory drug (DMARD) such as
sulfasalazine or gold injections, or cannot use these. Slightly
different conditions may apply in the case of the other
diseases.
Adalimumab will not be prescribed
if:
- your rheumatoid arthritis is not
active
- you have not tried standard
treatments first
- you are pregnant or
breastfeeding
- you have an infection.
Your doctor may decide not to
prescribe adalimumab if:
- you have had tuberculosis (TB) in the
past
- you have had other repeated
infections
- you have or have had multiple
sclerosis (MS)
- you have had cancer
- you have or have had a serious heart
condition
- you have lung fibrosis.
When and how do I take adalimumab?
Adalimumab is only available on prescription from a consultant
rheumatologist. The usual dose of adalimumab is 40 mg every other
week (once every 2 weeks), given by subcutaneous injection (an
injection under the skin). You, your partner, or another member of
your family can learn to give the injections. If this is not
possible, the injections can be given by your rheumatology nurse
specialist or district nurse.
If you are being prescribed adalimumab it is recommended that
you carry a biological therapy alert
card, which you can obtain from your doctor or
rheumatology nurse. 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.
How long does adalimumab take to work?
If you respond to adalimumab you will probably feel better in
2–12 weeks.
What are the possible risks or side-effects?
Reactions at the injection site (e.g. redness, swelling or pain)
may occur. These reactions are usually not serious.
Adalimumab has effects on the immune system (the body’s own
defence system), and therefore may make you more likely to develop
infections. You should tell your doctor or rheumatology nurse
straight away if you develop any of the following after starting
adalimumab:
You should stop adalimumab and see your doctor immediately
if:
- any of the symptoms listed above are severe
- 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 who are on treatments such as adalimumab which affect the
immune system. Therefore you may need antiviral treatment, which
your doctor will be able to prescribe.
It is possible that there may be a
slightly increased risk of certain types of cancer in patients
using anti-TNF drugs. Such a link has not been proven but is the
subject of current research. Please discuss this with your doctor
if you are concerned. Anti-TNF drugs have been associated with
certain types of skin cancer – these can be readily treated when
diagnosed early.
As yet, the long-term side-effects of
adalimumab are not fully understood because it is a relatively new
drug.
How can I reduce the risk of infection?
Because of its effects on the immune system, adalimumab may make
you more susceptible to food-borne infections such as salmonella
and listeria, which can result in food poisoning and other serious
illnesses. You can minimise this risk by avoiding foods such
as:
- raw eggs or products made from raw eggs (such as mayonnaise,
although many commercially available products are safe)
- unpasteurised milk
- mould-ripened soft cheeses (e.g. Brie and Camembert) and blue
cheeses (whether pasteurised or unpasteurised), feta and goat’s
cheese
- undercooked meat and poultry
- all types of pâté.
You should also wash all raw fruit and vegetables and ensure
that chilled ready meals are thoroughly cooked before eating. For
further advice see the Food Standards Agency website: www.eatwell.gov.uk/keepingfoodsafe.
What other treatments could be used instead of adalimumab?
A number of other drugs are used
in the treatment of rheumatoid arthritis and related conditions.
Your doctor will discuss these other options with you.
Will I need any special checks while on adalimumab?
You will have a chest x-ray and blood tests before starting
treatment. You may also have further blood tests while you are on
adalimumab to monitor its effects.
Can I take other medicines along with 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.
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.
Do not take over-the-counter preparations or herbal remedies
without discussing this first with your doctor, rheumatology nurse
or pharmacist.
What about immunisations?
If you are on adalimumab it is recommended that you should not
be immunised with ‘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
immunisation with you.
Pneumovax (which gives protection against the commonest cause of
pneumonia) and yearly flu vaccines are safe and recommended.
Can I drink alcohol while on adalimumab?
You can drink alcohol while on adalimumab. However, if you are
also taking methotrexate, you should only drink alcohol in small
amounts because methotrexate and alcohol can interact and damage
your liver.
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,
as you may be advised to stop the adalimumab temporarily before and
after surgery.
Does adalimumab affect fertility or pregnancy?
No-one knows the risk of adalimumab to an unborn baby. Women of
childbearing age therefore must use contraception
while on adalimumab. If you are planning to become pregnant, you
should continue to use contraception for 5 months after stopping
adalimumab.
What about breastfeeding?
You should not breastfeed if you are
on adalimumab. The drug may pass into the breast milk and could be
harmful to your baby.
Where can I obtain further information?
If you would like any further information about adalimumab, or
if you have any concerns about your treatment, you should discuss
this with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of
children.