Adalimumab

Patients on adalimumab should not be given any of the 'live' vaccines such as those for polio, rubella (German measles) and yellow fever, although inactivated vaccines are safe.

About : Always check the BNF link here

• Fully human monoclonal anti-TNF-alpha antibody
• Assuming 26 doses per year, the annual cost of adalimumab is £9155.64

Action

• Blocks stimulation of TNF receptors and down-regulates inflammatory response
• Adalimumab does not work immediately and it may be 3-12 weeks before benefit.
• Profile similar to Infliximab

Indications

• Rheumatoid arthritis, Severe psoriasis or Psoriatic arthritis
• Ankylosing spondylitis, Crohn's disease. Juvenile idiopathic arthritis.

Dose

• Adalimumab is administered subcutaneously as a 40 mg dose every other week

Dose range: It must be stored in a refrigerator (at 2-8°C).

Side effects

• Respiratory tract infections, leukopenia, anaemia, increased lipids
• Headache, abdominal pain, nausea and vomiting
• Elevated liver enzymes, rash, musculoskeletal pain and injection site reaction.

Contraindications

• Adalimumab is contraindicated in people with active tuberculosis or other severe infections, and people with moderate or severe heart failure
• Active tuberculosis should be treated with standard treatment for at least 2 months before starting adalimumab
• Patients on adalimumab should not be given any of the 'live' vaccines such as those for polio, rubella (German measles) and yellow fever, although inactivated vaccines are safe.
• Pharmacologic inhibition of tumour necrosis factor-α (TNF-α) for the treatment of chronic inflammatory disease such as Crohn’s or psoriasis increases the risk of developing active tuberculosis among those with latent infection.

References

• Adalimumab in BNF