Adalimumab
A DRUG Information Sheet
What is adalimumab?
Adalimumab (brand name Humira) is a type of drug known as anti-TNF. In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is present in the blood and joints in excessive amounts, where it increases inflammation. Anti-TNF drugs block the action of TNF and so can reduce inflammation. In this way they can help people with active rheumatoid arthritis and other types of arthritis.
Why am I being prescribed adalimumab?
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). It will only be prescribed if your rheumatoid arthritis is active and if you have already tried methotrexate and another standard 'second-line' treatment (e.g. sulfasalazine, gold injections). It may also be prescribed if you cannot tolerate other treatments. Slightly different conditions may apply in the case of the other diseases. Adalimumab is available only on prescription from a consultant rheumatologist.
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?
The usual dose of adalimumab is 40 mg every other week (once every 2 weeks), given by subcutaneous injection (an injection under the skin, like insulin injections for diabetes). 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.
How long will 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 seldom serious.
Adalimumab has effects on the immune system (the body's own defence system), and therefore may make you more likely to develop infections. If you develop a sore throat or other symptoms of infection, if you have a fever, or if you develop any other new symptoms after starting adalimumab, you should tell your doctor or rheumatology nurse straight away. If any of these symptoms are severe, you should stop adalimumab and see your doctor immediately.
If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should stop adalimumab and see your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on treatment such as adalimumab which has effects on the immune system. Therefore you may require antiviral treatment.
Rarely, people may be allergic to adalimumab. If this is the case with you, the drug will have to be stopped.
As yet, the long-term side-effects of adalimumab are not known because it is a relatively new drug.
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 (see arc leaflet 'Drugs and Arthritis'). Your doctor will discuss these other options with you.
How can I reduce the risk of infection?
As a result of its action on the immune system, adalimumab may make you more susceptible to food-borne infections such as salmonella and listeria, which may 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.
Do 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.
May I take other medicines along with adalimumab?
Adalimumab may be prescribed along with other drugs, including methotrexate (see separate arc leaflet '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 taking adalimumab.
Adalimumab is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you may 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.
Can I have immunisations while 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 and yearly flu vaccines are safe and recommended.
May I drink alcohol while taking adalimumab?
You may drink alcohol while taking 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.
May I continue with adalimumab if I am to have an operation?
If you are to undergo surgery, please inform your doctor, as you may be advised to stop the adalimumab temporarily before and after surgery.
Does adalimumab affect pregnancy?
No-one knows the risk of adalimumab to an unborn baby. Women of child-bearing age 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 while on adalimumab. The drug could pass into the breast milk and the risk to the baby is unknown.
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.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
