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 compared to other therapies including methotrexate.
• Active & progressive psoriatic arthritis in adults who have had an inadequate response to therapy with basic disease-modifying therapeutics. Primarily used in combination therapy with methotrexate (to prevent the formation of autoantibodies against adalimumab), also applicable as monotherapy in case of intolerance to MTX.
• In the meantime, an approval as first-line therapy for psoriasis has also been obtained.
• Adalimumab can also be used in children with severe plaque psoriasis who did not respond 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