Adalimumab Patient Tips

Medically reviewed by Carmen Pope, BPharm. Last updated on Feb 27, 2024.

1. How it works

• Adalimumab is a tumor necrosis factor (TNF) inhibitor that may be used to treat several different inflammatory conditions, such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, uveitis, and others, depending on the FDA approval criteria for Humira or other branded biosimilar.
• Adalimumab works by binding specifically to TNF-alfa, which is a signaling protein (also called a cytokine) that is released by white blood cells during inflammation and can trigger cell damage or cell death. By binding to TNF-alfa, adalimumab blocks the action of TNF-alfa, reducing inflammation and tissue destruction. Increased levels of TNF-alfa have been found in conditions such as rheumatoid arthritis, psoriasis, and ankylosing spondylitis.
• Adalimumab belongs to the class of medicines called TNF-alfa (alpha) inhibitors. It may also be called a biologic.

2. Upsides

• May be used to treat many different diseases where inflammation can lead to pain and swelling.
• Humira and all other adalimumab biosimilar brands are approved to treat ankylosing spondylitis, Crohn's disease, juvenile idiopathic arthritis (JIA), plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, and ulcerative colitis, although some are only approved for use in adults. All except for Idacio are approved for adults with Hidradenitis Suppurativa (Humira is also approved for those 12 years and older), and all except Yuflyma can treat uveitis (Humira is also approved for those 2 years and older). Abrilada, Cyltezo, and Simlandi are interchangeable. See here for a comparison table of adalimumab biosimilars and their indications and interchangeability status.
• Most people will start to feel relief from their symptoms within 2 to 12 weeks. Results vary depending on the condition being treated, how well you tolerate treatment, and interacting medications.
• People can be taught how to self-administer adalimumab injections under the skin and most people find it easy to do this.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• A headache; cold symptoms (such as congestion and pain in the sinuses, sneezing, and a sore throat); a rash; or redness, bruising, swelling, or itching at the injection site are the most commonly reported side effects.
• Adalimumab can only be given as an injection; however, people can be taught how to self-administer it. Most brands are available as prefilled pens or syringes.
• It does not cure inflammatory conditions; however, it does help relieve symptoms and may prevent your condition from worsening.
• Adalimumab is an immunosuppressant and can lower the ability of your immune system to fight bacterial, viral, or fungal infections or make an infection worse. It may cause some infections, such as tuberculosis, to become active again. Some people have died from these infections. All patients must be screened for TB before starting treatment with adalimumab and it should not be started in any person who currently has an infection or symptoms of an infection. It may also lead to the reactivation of the hepatitis B virus.
• Adalimumab may increase the risk of developing certain kinds of fungal infections (such as histoplasmosis, coccidioidomycosis, or blastomycosis), which are common in certain parts of the country (such as the Ohio and Mississippi River valleys).
• It interacts with several different medicines (see interactions below), some of which may increase your risk of infection. Live vaccines such as the nasal flu vaccine (FluMist); measles, mumps, rubella (MMR); chickenpox; and yellow fever vaccines should not be administered to a person taking adalimumab. Other vaccinations are usually compatible.
• Use of adalimumab may increase your risk of developing certain cancers, such as lymphoma, or a rare type of cancer called hepatosplenic T-cell lymphoma. Teenagers and young men with Crohn's disease or ulcerative colitis appear to be more susceptible.
• Must be stored in a refrigerator.
• Adalimumab has not been studied during pregnancy or breastfeeding and is possibly not safe. Tell your doctor if you are pregnant or intend to become pregnant.
• Although less expensive than Humira, adalimumab biosimilars are still expensive. The ease of switching between biosimilars depends on the concentration and citrate content of the product (see What is a biosimilar). Abrilada, Cyltezo, and Simlandi are interchangeable with Humira and can be substituted for Humira at the pharmacy level, subject to state pharmacy laws.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Adalimumab is a TNF-alfa inhibitor that may be used to treat a wide range of different inflammatory conditions, such as rheumatoid Arthritis, psoriasis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis. Adalimumab can lower your immune system's ability to fight infections such as those caused by bacteria, fungi, or viruses. It may also increase your risk of developing certain types of cancer. Several biosimilars are available and Abrilada, Cyltezo, and Simlandi are interchangeable with Humira.

5. Tips

• Before starting treatment with adalimumab, tell your doctor if you have tuberculosis (TB), or have been in close contact with someone with TB (for example, someone in your household). Tell your doctor if you were born in, lived in, or traveled to countries where there is more risk of getting TB. Ask your doctor if you are not sure. Symptoms of TB may include a cough, low-grade fever, weight loss, or loss of body fat and muscle.
• Also tell your doctor if you are scheduled to receive a vaccination, as some vaccinations are not compatible with adalimumab. Children should be brought up to date with all vaccines in current immunization guidelines before starting adalimumab. Because the flu shot is not a live virus, people taking adalimumab should receive this yearly.
• Adalimumab may also not be suitable for people currently with or who have had cancer, hepatitis B, diabetes, congestive heart failure, any numbness or tingling, a nerve-muscle disorder such as multiple sclerosis or Guillain-Barre syndrome, an allergy to latex rubber, or in those scheduled to have major surgery. Make sure your doctor knows if any of these apply to you.
• Take your adalimumab pen or prefilled syringe out of the refrigerator and allow it to warm up naturally to room temperature for 30 minutes before administering it. Once out of the refrigerator, it may be kept at room temperature (up to a maximum of 77°F [25°C]) for a period of up to 14 days. If it is not used within this time, throw it away. If you are traveling, follow the package instructions for storage during travel.
• Only administer the dosage prescribed by your doctor. Do not exceed the recommended dosage and do not stop adalimumab without your doctor's advice. Always dispose of your used pen or syringe in an FDA-approved sharps bin.
• if you develop an allergic reaction to adalimumab (such as a skin rash, facial swelling, or difficulty breathing) contact your doctor immediately. Call your doctor if you are using adalimumab and your condition gets worse, or if you develop liver problems (nausea, abdominal pain, skin yellowing), joint pain, or nerve pain.
• Talk to your doctor or pharmacist before taking any other medications with adalimumab, including those brought over the counter. Some antibiotics may not work as intended when taken with adalimumab.
• Call your doctor if you develop any symptoms of an infection such as fever, sweats or chills, muscle aches, coughing, warm, painful or red skin or sores on your body, diarrhea, stomach pain, shortness of breath, blood in phlegm, or burning when you urinate. Try to avoid being near people who currently have infections.
• People without insurance or who are unemployed may be eligible to receive Humira at no cost from the AbbVie Patient Assistance Program (my AbbVie Assist) or another foundation if they meet certain income criteria. Other adalimumab biosimilars may also have Patient Assistance Programs.
• Tell your doctor if you are pregnant or you become pregnant while taking adalimumab. Although the effects of adalimumab during pregnancy have not been studied it is recommended that you don't become pregnant while taking it.

6. Response and effectiveness

• Most people will start to feel relief from their symptoms within 2 to 12 weeks.
• Response rates vary depending on the condition being treated, but for rheumatoid arthritis, patients reported the following response rates after receiving adalimumab 40mg every second week: a 20% improvement from their baseline scores was reported by 65% of people; a 50% improvement from their baseline scores was reported by 52% of people; a 70% improvement from their baseline scores was reported by 24% of people.
• For people with psoriatic arthritis, a 75% improvement in baseline psoriasis severity scores was reported by 59% of people, and a 90% improvement in baseline scores was reported by 42% of people.
• For ankylosing spondylitis, an improvement of 20% in their baseline scores was reported by 58% of people, a 50% improvement was reported by 38% of people, and an improvement of 70% was reported by 23% of people.
• For Crohn's disease, 21% to 36% achieved clinical remission by week 4 and 52% to 58% achieved a clinical response.
• For ulcerative colitis, 16.5% to 18.5% experienced symptom improvement after 8 weeks.

7. Interactions

Medicines that interact with adalimumab may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with adalimumab. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with adalimumab include:

• anticonvulsants, such as fosphenytoin
• antivirals, such as ganciclovir
• benzodiazepines, such as alprazolam, clobazam
• chemotherapy medications, such as fluorouracil
• chloroquine
• corticosteroids, such as budesonide, cortisone, or dexamethasone
• cyclosporine
• heart medications, such as amiodarone, felodipine, flecainide
• hormones, such as ethinyl estradiol or levonorgestrel
• hydroxyurea
• immunosuppressants, such as azathioprine or mercaptopurine
• interferons
• live vaccinations, such as chickenpox, MMR, yellow fever, or the nasal flu vaccine
• medications that lower cholesterol, such as atorvastatin or simvastatin
• methotrexate, although a dosage adjustment is not necessary
• other biologics, such as anakinra, abatacept, etanercept, or rituximab (no added benefit with an increased risk of serious infections)
• probiotics, such as lactobacillus
• theophylline
• warfarin.

Note that this list is not all-inclusive and includes only common medications that may interact with adalimumab. You should refer to the prescribing information for adalimumab for a complete list of interactions.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use adalimumab only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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