Adalimumab

Recombinant monoclonal IgG1 antibody, consisting only of human sequences, against tumor necrosis factor alpha (TNF-α) with specific binding to TNF-alpha and without affinity to other members of the human TNF family. Pharmacologically the antibody belongs to the group of "immune response modifiers".

• Neutralization of the biological function of TNF-alpha by highly specific binding to the TNF-alpha molecules and inhibition of the interaction with the cellular p55 and p75 TNF receptors
• Secondarily, the production and secretion of IL-1 and IL-6 as well as leukocyte migration and expression of adhesion molecules are inhibited.

Moderate to severe active rheumatoid arthritis in adults with treatment failure to other therapies including methotrexate.

Active & progressive psoriatic arthritis in adults who have had an inadequate response to therapy with baseline disease modifying agents. Primarily used in combination therapy with methotrexate (to prevent the formation of autoantibodies against adalimumab); can also be used as monotherapy if MTX is not tolerated.

In the meantime, there is also an approval for psoriasis as a first-line therapy.

Adalimumab can also be used in children with severe plaque psoriasis who have not responded adequately to methotrexate.

Plaque psoriasis

Off label use: Acrodermatitis continua suppurativa (see there)

• Often local reactions at the injection site such as redness, pain, pruritus.
• Occasional infections of the respiratory system as well as urinary tract infections, herpes simplex, nausea, diarrhoea, headaches.
• Immunogenicity: Anti-Adalimiúmab antibodies occur in 6-50% of patients. However, this does not exclude a good clinical response (Hsu L et al. (2014).

Humira

• Remember! Contraception for women during therapy until at least 5 months after the end of therapy and for men during use until 70 days after the last injection of Adalimumab!

• New study data indicate that Adalimumab leads to a significant improvement of disease symptoms in patients with moderate to severe psoriasis. In addition, regular use of the fully human monoclonal antibody may reduce the risk of further aggravation.
• A biosimilar has been available since 2018 (Hexal/Hyrimoz®)

1. Lehnen M et al (2004) New therapeutic options for psoriatic arthritis: TNF inhibitors. German Med Weekly 129: 634-638
2. Hsu L et al (2014) Antidrug antibodies in psoriasis: a systematic review. Br J Dermatol 170:261-273.
   Menter A et al. (2008) Adalimumab therapy for moderate to severe psoriasis. A randomized, controlled phase III trial. J Am Acad Dermatol 58: 106-115
3. Molloy E et al (2004) Morbidity and mortality in rheumatoid patients during treatment with adalimumab and infliximab. Rheumatology (Oxford) 43: 522-523
4. Shikiar R et al (2007) Adalimumab treatment is associated with improvement in health-related quality of life in psoriasis: patient-reported outcomes from a Phase II randomized controlled trial. J Dermatolog Treat 18: 25-31
5. Toussirot E et al (2004) The use of TNF-alpha blocking agents in rheumatoid arthritis: an overview. Expert Opinion Pharmacother 5: 581-594
6. Wozel G, Sticherling M (2007) Systemic psoriasis therapy - the next step. dermatologist 58: 515-524