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Adalimumab

Adalimumab is used to treat Crohn’s disease. Tumour necrosis factor alpha (TNF-α) causes inflammation and is thought to play a central role in Crohn’s disease. Adalimumab is a human-derived genetically engineered drug that binds to TNF-α, inhibiting its activity and thereby reducing inflammation.

Is it licensed and approved by NICE?

Yes – it is licensed to treat severe active Crohn’s disease in patients who have not responded to steroids and/or an immunosuppressant (such as mercaptopurine), or who are intolerant to or have medical contraindications to such therapy. NICE have approved its use for up to one year in the first instance and thereafter only following re-assessment by a specialist.

Ideally patients should be treated with either a mercaptopurine or methotrexate for the FIRST 6 MONTHS of treatment with adalimumab to improve its effect on Crohn’s disease. Thereafter treatment with mercaptopurine or methotrexate may be stopped but this is subject to discussion.

Who should avoid adalimumab?
  1. Patients with TB or other severe infections, sepsis, abscesses and opportunistic infections (patient should have a CXR to exclude TB)
  2. Patients with multiple sclerosis or optic neuritis
  3. Patients with moderate or severe heart failure
  4. Patients with a history of hypersensitivity to adalimumab
  5. Patients towards the end of pregnancy or breast feeding (stop adalimumab before last trimester)
  6. Patients with history of lymphoma or cancer
How to give adalimumab
  1. Induction: 160mg at week 0 (either as four injections in one day or two injections per day for two consecutive days) followed by 80mg at week 2. If patient is NOT taking immunosuppression, then pre-treat with IV hydrocortisone 100mg & oral chlorphenamine 4mg 30 minutes before starting adalimumab.
  2. Maintenance treatment: 40mg alternate weeks via subcutaneous injection. If patients experience decrease in response dose may be increased to 40mg every week.
Adverse effects

All patients should be observed for at least 1-2 hours after induction doses for side effects:

  1. Acute infusion reaction (4%). Usually occurs during first or second dose. If develop shortness of breath or itchy rash, please tell the nurse or doctor.
  2. Other side-effects include headache, abdominal pain, nausea (20-30%)
  3. Serious infections (4%), including TB