Adalimumab for rheumatoid arthritis

Examples

Generic Name	Brand Name
adalimumab	Humira

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

How It Works

Adalimumab reduces the effects of tumour 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

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.¹

How Well It Works

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 medication, with improvements noticeable after 1 week of treatment.² 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.³

Side Effects

Cases of serious, even fatal, infections have been reported during treatment with adalimumab.

Risk of infection

Adalimumab decreases the activity of your body's immune system, which increases the risk of a serious bacterial infection. Some people who take adalimumab develop an infection that requires oral antibiotics; a smaller number of people will develop an infection that requires intravenous antibiotics and hospitalization. Contact your health professional if you develop any of the following symptoms:

• Fever or chills
• Increased frequency of or burning during urination
• A cough with yellow sputum or shortness of breath
• A skin infection
• Severe abdominal pain or diarrhea
• A severe sore throat
• Sinus pain with yellow mucus
• A painful, burning rash in a band across one side of your body (shingles)
• Painful, widespread mouth sores

Other side effects may include:

• Allergic reactions.
• Pain at the injection site.
• Nausea.
• Flu-like symptoms.

Adalimumab can reactivate tuberculosis (TB) in people who have been previously infected with TB. Before starting adalimumab treatment, you should be screened with a tuberculin skin test and/or a chest X-ray. If the skin test is positive or the chest X-ray suggests a prior history of exposure to TB, you will need treatment to prevent active TB.¹

People with rheumatoid arthritis have a slightly higher risk of getting cancer of the lymph glands, called lymphoma, than people without rheumatoid arthritis. But lymphoma is rare even for people with rheumatoid arthritis. Experts do not know why this risk is higher for people with rheumatoid arthritis—it may be because the disease is severe or because of the medicines used to treat it. Studies are currently under way to explain this. Talk with your doctor about the benefits and risks of DMARD therapy.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Adalimumab is a new TNF inhibitor, approved by Health Canada's Therapeutic Products Directorate (TPD). Like etanercept and infliximab, adalimumab is significantly more expensive than DMARDs such as methotrexate and sulfasalazine.¹

Adalimumab should not be used by pregnant women or women of child-bearing 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.

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Author:	Carrie Henley Robin Parks, MS	Last Updated: October 13, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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