Humira (Adalimumab)

Humira is prescribed across rheumatology, dermatology, gastroenterology and ophthalmology where tumour necrosis factor-alpha drives chronic inflammation.

• Rheumatoid and juvenile idiopathic arthritis: reduces joint inflammation, slows structural damage and improves physical function.
• Psoriatic arthritis and ankylosing spondylitis: relieves peripheral and axial symptoms where conventional therapy is inadequate.
• Crohn's disease and ulcerative colitis: induces and maintains remission in moderate to severe disease.
• Plaque psoriasis and hidradenitis suppurativa: clears skin lesions and reduces abscess and nodule formation.
• Non-infectious uveitis: controls intraocular inflammation and reduces corticosteroid dependence.

• Adalimumab is a fully human monoclonal antibody that binds with high affinity and specificity to tumour necrosis factor-alpha, a cytokine central to inflammatory and immune responses. By binding both soluble and membrane-bound TNF-alpha, it blocks the cytokine from engaging the p55 and p75 cell-surface receptors. This neutralisation lowers downstream inflammatory mediators, reduces leucocyte migration into inflamed tissue, and in the joints slows the cartilage and bone destruction that drives long-term disability.

Adverse effects reflect immune suppression; report fever, persistent cough or unusual symptoms to the treating clinician promptly.

Common Side Effects

• Injection site reactions: redness, itching, swelling or pain that usually settles without treatment.
• Upper respiratory tract infections: sinusitis, nasopharyngitis and bronchitis occur frequently.
• Headache and rash: generally mild and manageable during continued therapy.
• Nausea and abdominal pain: mild gastrointestinal upset, often early in treatment.

Serious or Rare Side Effects

• Serious infections: tuberculosis, invasive fungal and opportunistic infections may become disseminated; seek urgent care.
• Malignancy: lymphoma and other cancers have been reported, including hepatosplenic T-cell lymphoma in younger patients.
• Demyelinating disease and heart failure: new or worsening neurological or cardiac symptoms require immediate review.
• Hepatitis B reactivation and blood disorders: monitor for jaundice, bruising or persistent sore throat.

Safe use depends on screening before initiation and vigilance for infection throughout treatment.

• Screen for tuberculosis: test for latent infection and treat it before starting therapy.
• Test for hepatitis B: carriers risk reactivation and need monitoring during and after treatment.
• Avoid live vaccines: complete all required immunisations before initiation.
• Use caution in heart failure: TNF blockade may worsen moderate to severe cardiac failure.
• Withhold during active infection: do not start or continue while a serious infection is present.
• Store at 2-8°C: keep refrigerated in the original carton, do not freeze, and protect from light.

All concurrent immunomodulators, vaccines and narrow therapeutic index medicines should be reviewed with a clinical pharmacist before Humira is administered.

Major Interactions (Avoid)

• Anakinra and abatacept: combined biologic therapy raises serious infection risk without added benefit.
• Other TNF inhibitors: concurrent use compounds immunosuppression and is not recommended.
• Live attenuated vaccines: measles, mumps, rubella, varicella and yellow fever may cause infection.

Moderate Interactions (Monitor Closely)

• Methotrexate: reduces adalimumab clearance; commonly co-prescribed, but monitor for toxicity.
• Narrow therapeutic index drugs: normalising cytokine levels can alter warfarin, ciclosporin and theophylline handling.
• Other immunosuppressants: azathioprine and ciclosporin add to infection risk; monitor blood counts.