Adalimumab is a drug substance that binds to tumor necrosis factor-alpha (TNF-alpha), a messenger of the immune system. Under the trade name Humira, adalimumab is used for inflammatory rheumatic diseases.
What is adalimumab?
Under the trade name Humira, adalimumab is used for inflammatory rheumatic diseases. Adalimumab is a human monoclonal antibody that binds specifically to TNF-alpha and belongs to the group of drugs known as TNF blockers. By binding to TNF-alpha, it prevents the messenger substance from functioning. Adalimumab belongs to the group of drugs known as biologics. These are drugs that are manufactured using biotechnological methods. Adalimumab is produced in so-called CHO cells, a cell line from Chinese hamster ovaries. Nevertheless, unlike other antibodies used as drugs, adalimumab consists exclusively of human components.
Pharmacologic Action
TNF-alpha is involved in inflammatory responses in the body as a messenger of the immune system. In inflammatory rheumatic diseases, it is present in increased concentrations in the synovial fluid and is crucially involved in the development of the inflammatory processes. Blocking TNF-alpha with adalimumab can reduce inflammation and other symptoms in these diseases. Adalimumab binds to TNF-alpha so that it cannot perform its function as a messenger substance. Inflammation parameters such as C-reactive protein and interleukin-6 decrease. The levels of specific enzymes involved in cartilage destruction in inflammatory rheumatic diseases also decrease. Pain and swelling improve. Adalimumab acts quickly and inhibits disease progression. However, since TNF-alpha plays an important role in the body’s immune system, adalimumab also inhibits desirable processes of the messenger substance in the human body. Thus, the immune system is weakened, leading to an increased risk of infection. There is a possibility of increased likelihood of tumor development such as malignant lymphoma formation. Adalimumab has a half-life of 14 to 19 days in the body. This means that after this period, only half of the active ingredient can be detected in the blood.
Medical use and application
Adalimumab may be used in patients with various inflammatory rheumatic diseases in which other therapy has been unsuccessful or no other therapy can be administered. In adult patients, these include moderate to severe active rheumatoid arthritis, active and progressive psoriatic arthritis, axial spondyloarthritis, moderate to severe Crohn’s disease and ulcerative colitis, and psoriasis. For children, adalimumab may be used for severe active Crohn’s disease, active polyarticular juvenile idiopathic arthritis, and active enthesitis-associated arthritis. In all cases, prescribing by a physician and medical monitoring during treatment is required. Adalimumab is available as a solution for injection. It is administered as a prefilled syringe or prefilled pen. It is also available in a vial for children. Adults typically receive a dose of 40 mg of adalimumab every two weeks, injected under the skin. Patients can do this themselves after being instructed by their doctor. Depending on the clinical picture, a higher initial dose may be required. In children up to four years of age, the maximum dose is 20 mg every two weeks and is calculated according to body size and weight. The effect of adalimumab occurs very quickly and sometimes on the first day. Patients usually feel relief of symptoms after two to three weeks. However, the maximum effect of the drug is often only achieved after two to three months. If the physician and patient decide to treat the patient with adalimumab, it must be long-term, otherwise the symptoms will worsen again.
Risks and side effects
Very common side effects of adalimumab include respiratory infections, low white or red blood cell counts, high levels of lipids in the blood, headache, abdominal pain, nausea and vomiting, skin rash, joint and muscle pain, reactions such as redness at the injection site, and increased levels of liver enzymes. Adalimumab should not be used in patients with active tuberculosis, severe infections, or heart failure.In addition, certain vaccinations should not be given during treatment with adalimumab. Because reactivation of tuberculosis may occur as a result of adalimumab, the treating physician examines patients for signs and symptoms of tuberculosis before starting treatment.
