Adalimumab is an active pharmaceutical ingredient that binds to tumor necrosis factor-alpha (TNF-alpha), a messenger substance of the immune system. Under the trade name Humira®, adalimumab is used in inflammatory rheumatic diseases.
What is adalimumab?
Adalimumab is a human monoclonal antibody that specifically binds to TNF-alpha and belongs to the group of so-called TNF blockers. By binding to TNF-alpha, it prevents the function of the messenger substance. Adalimumab is one of the so-called biologics.
This includes drugs that are manufactured using biotechnological methods. Adalimumab is produced in so-called CHO cells, a cell line from the ovaries of the Chinese hamster. Nevertheless, unlike other antibodies used as drugs, adalimumab consists exclusively of human components.
Pharmacological effect
TNF-alpha is involved in inflammatory reactions in the body as a messenger substance of the immune system. In inflammatory rheumatic diseases, it is present in the joint fluid in increased concentration and is decisively involved in the development of the inflammatory processes.
By blocking TNF-alpha with adalimumab, inflammation and other symptoms in these diseases can be reduced. Adalimumab binds to TNF-alpha so that it cannot carry out 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 works quickly and stops the disease from getting worse. However, since TNF-alpha plays an important role in the body's immune system, adalimumab also inhibits desired processes of the messenger substance in the human body. This weakens the immune system, which increases the risk of infection. There is a possibility of an increased likelihood of developing tumors such as the formation of malignant lymphomas. Adalimumab has a half-life of 14 to 19 days in the body. This means that after this period only half of the active substance can be detected in the blood.
Medical application & use
Adalimumab can be used in patients with a variety of inflammatory rheumatic diseases for whom other therapy has not worked 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 can be used in severely active Crohn's disease, active polyarticular juvenile idiopathic arthritis, and active enthesitis-associated arthritis. In any case, a prescription from a doctor and medical supervision during treatment are required. Adalimumab is available as a solution for injection. It is given as a pre-filled syringe or pre-filled pen. It is also available in a vial for children.
Adults usually receive a dose of 40 mg adalimumab given by injection under the skin every two weeks. After instruction by the doctor, patients can do this themselves. Depending on the clinical picture, a higher starting dose may be required. For children up to four years of age, the maximum dose is 20 mg every two weeks and is calculated based on height and weight. Adalimumab takes effect very quickly and in some cases on the first day.
Most patients feel relief of symptoms after two to three weeks. However, the maximum effect of the drug is often only reached after two to three months. If the doctor and patient decide to start treatment with adalimumab, this must be long-term, as otherwise the symptoms worsen again.
Risks & side effects
The most common side effects with adalimumab are respiratory infections, low white or red blood cell counts, high levels of fat in the blood, headache, abdominal pain, nausea and vomiting, 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. Since adalimumab can reactivate tuberculosis, the treating doctor examines the patient for signs and symptoms of tuberculosis before starting treatment.
