Adalimumab

Adalimumab - How to use | Precautions

Adalimumab is a human monoclonal antibody which belongs to the group of medicines called inhibitors of tumor necrosis factor alpha. It works by preventing the binding of the TNF alpha to p55 receptor which results in amelioration of symptoms in patients suffering from rheumatoid arthritis.

Precautions

Adalimumab should not be used in patients who have tuberculosis, as there are reported cases of tuberculosis in patients taking this drug. A meta-analysis, which included 7009 patients who were taking this medication showed that nine patients experienced tuberculosis induced by this drug.1

One study that examined side effects of this drug has shown that Adalimumab double the risk of serious infection, and should not be used in patients who already have an active infection or sepsis.2 If you notice symptoms of an infection (e.g. pharyngitis, cough, fever, shortness of breath or others) contact your physician immediately. Occurrence of opportunistic infections with possible fatal outcome have also been reported.

The same study indicates that this medication can cause worsening of symptoms in patients suffering from congestive heart failure. For this reason, Adalimumab is contraindicated in patients with heart failure.

Kohli R. et al have reported the case of a 78 year-old man who received Adalimumab and experienced acute lung injury only few hours after starting this medicine. The author emphasizes the significance of this adverse effect (as it can be fatal), and points to the need for physicians to react immediately if patient experience tachypnea (rapid breathing).3

Adalimumab should be used cautiously in the following situations:

  • In patients suffering from multiple sclerosis
  • In patients with Guillain-Barre syndrome
  • In patients with anemia
  • In patients who have low white blood cell count

Adalimumab, pregnancy and lactation

Studies were conducted in monkeys to determine Adalimumab's toxicity during pregnancy. It showed no toxic effects on the fetus. However, so far there is only one case report about its use in human pregnancy.4 Vesga L. et al have reported a case of 34 year-old pregnant women who received a total of 38 doses during pregnancy, and she has given a birth to a completely healthy baby. However, based on Adalimumab's mechanism of action, it is expected that Adalimumab will compromise immune system and increase the risk of infection in infants. It is therefore recommended that newborns whose mothers took this drug during pregnancy do not receive the vaccine during the first six months of life.

Acording to the Patient Information Leaflet, breastfeeding should be avoided and mother should not breastfeed for five months after last dose.

How to use

Adalimumab is administered subcutaneously only by trained medical personnel. Your doctor will calculate the dose that is best for you based on your body surface area. This drug can also be used in children for the treatment of polyarticular juvenile idiopathic arthritis.

Interactions

Adalimumab should not be administered concurrently with the following drugs:

  • Corticosteroids, such as:
  • Drugs used in the treatment of HIV, such as: zidovudine
  • Drugs used for the treatment of autoimmune diseases (such as rheumatoid arthritis), such as:
    • abatacept
    • azathioprine
    • anakinra
    • tocilizumab
  • Altretamine - a drug used for the treatment of ovarian cancer
  • Melphalan - a drug used for the treatment of multiple myeloma
  • Other drugs used for treatment of various types of cancer, such as:

These drugs have immunosuppressant activity and concomitant use with Adalimumab increases the risk of of serious infections.

Side effects

Adalimumab may cause the following side effects:

  • Different types of infections
  • Decreased number of leukocytes in the blood
  • Decreased number of erythrocytes in the blood
  • Pancytopenia
  • Decreased number of platelets in the blood
  • Decreased levels of potassium, phosphate and calcium in the blood
  • High blood glucose levels
  • Guillain-Barre syndrome
  • Optic neuritis
  • Visual impairment
  • Double vision
  • Headache
  • Migraine
  • Dizziness
  • Hand numbness
  • Hearing impairment
  • Rapid heart rate
  • Congestive heart failure
  • Rapid breathing
  • Difficulty breathing
  • Disruption of taste
  • Liver injury
  • Lung injury
  • Increased sweating
  • Nocturia

References

  1. NCBI link 1
  2. NCBI link 2
  3. NCBI link 3
  4. NCBI link 4