Adalimumab (Humira®, Amjevita®, Abrilada®, Cyltezo®, Idacio®, Hadlima®, Hulio®, Hyrimoz® and Yusimry®): everything there is to know!

What is adalimumab?

Adalimumab is an immunosuppressive drug that belongs to the family of anti-TNF agents. It contains a monoclonal antibody produced by biotechnology. Adalimumab is designed to bind to a protein, Tumor Necrosis Factor (TNF) which is involved in certain inflammatory processes, and neutralize its biological function by blocking its interaction with the p55 and p75 TNF receptors on the cell surface. Its activity being thus blocked, inflammation caused by various chronic inflammatory diseases is reduced. The drug therefore helps to ease the symptoms and/or slow the progression of certain conditions.

Adalimumab is used in the management of the following conditions:

• Crohn's disease, 
• Ulcerative colitis, 
• Psoriasis, 
• Psoriatic arthritis, 
• Rheumatoid arthritis, 
• Ankylosing spondylitis, 
• Juvenile idiopathic arthritis, 
• Hidradenitis suppurativa, 
• Uveitis. 

Humira® was the first medicine on the market to contain adalimumab as the active substance. Since 2017, other biosimilars have become available (Amjevita®, Abrilada®, Cyltezo®, Idacio®, Hadlima®, Hulio®, Hyrimoz® and Yusimry®), with identical efficacy and safety.

Adalimumab is administered via subcutaneous injection, using a pre-filled syringe or an injection pen. If necessary, a nurse can show the patient how they can administer the drug themselves. Adalimumab should be stored in a refrigerator (39,2°F) and the cold chain should be maintained. A small cooling bag can be provided to you by the pharmacy. After use, the injection pen or the syringe must be disposed of in your sharps disposal container; once it is full, follow your community guidelines for getting rid of it.

What follow-up care for patients on adalimumab?

Allergic reactions are possible after the injection. The first injection should be given in a suitable health care facility where emergency treatment can be given without delay in case of problems.

In addition, adalimumab lowers the immune system responses and thus increases the risk of infection. Before administration, a thorough check-up is necessary, for example for tuberculosis or hepatitis B.

Particular vigilance on the part of the patient is required throughout the treatment. If your temperature rises above 38°C, if you experience coughing, weight loss, toothache or burning sensation while you urinate, you must see your doctor as soon as possible. 

Follow-up care must be provided throughout the treatment and for 5 months after the end of the treatment. This care must be reinforced if the patient has a history of frequent or chronic infections, a predisposition to infections (particularly in the case of diabetes), chronic bronchitis (COPD) or multiple sclerosis.

Frequent blood tests should be carried out (blood count, transaminase levels).

Blood disorders such as persistent fever, bruising with no obvious cause, bleeding, pallor, etc. should be reported to your doctor promptly.

Anti-TNF treatments increase the risk of cancer, especially lymphoma and melanoma, so regular skin examinations are recommended, especially for people who have risk factors for skin cancer.

It is essential that you tell your dentist or surgeon before any surgery or dental work that you are taking adalimumab.

All vaccines can be given and are even recommended when the immune system is weakened (e.g. flu vaccine or pneumococcal vaccine). The only vaccines that should be avoided are the so-called live attenuated vaccines such as the yellow fever vaccine (necessary for travel to certain countries) or the BCG vaccine against tuberculosis.

What are the contraindications for taking adalimumab? 

This medicine should not be used in the following cases:

• Active tuberculosis or other serious infection, such as sepsis or opportunistic infection;
  
• Heart failure.

What are the side effects of adalimumab? 

The most common side effects (more than 10% of patients) of adalimumab (Humira®, Amjevita®, Abrilada®, Cyltezo®, Idacio®, Hadlima®, Hulio®, Hyrimoz® and Yusimry®) are:

• Injection site reaction (redness, swelling, pain or itching), 
  
• Upper respiratory tract infection (bronchitis, pneumonia, sinusitis),
  
• Headache,
  
• Muscle pain,
  
• Nausea,
  
• Vomiting,
  
• Abdominal pain,
  
• Skin rash,
  
• Increased lipids in the blood,
  
• Increased transaminases (enzymes found in the body's cells, particularly in the muscles and liver).

Frequent side effects (1-10% of patients):

• Flu,
  
• Infections of the skin, ears, mouth, urinary or genital tract,
  
• Fatigue,
  
• Depression,
  
• Anxiety,
  
• Insomnia,
  
• Tingling,
  
• Migraine,
  
• Visual disturbances, conjunctivitis, swelling of the eyes,
  
• Asthma, shortness of breath, cough,
  
• Dizziness,
  
• Tachycardia,
  
• High blood pressure,
  
• Hot flushes, sweating, 
  
• Hair loss,
  
• Poor wound healing, bleeding disorders,
  
• Presence of blood in the urine.
  

Uncommon side effects (less than 1/100 patients):

• Double vision, 
  
• Erectile dysfunction,
  
• Sepsis,
  
• Meningitis,
  
• Tuberculosis,
  
• Melanoma,
  
• Lymphoma,
  
• Heart failure,
  
• Lung inflammation... 

If you experience an adverse reaction that you think may be due to one of these treatments: Humira®, Amjevita®, Abrilada®, Cyltezo®, Idacio®, Hadlima®, Hulio®, Hyrimoz® and Yusimry®, you can report it online.

Some of the side effects of this medication may still occur 4 months after stopping treatment.