Adalimumab
A fully human anti-TNF-alpha antibody injected under the skin for rheumatoid arthritis, psoriasis, Crohn's disease and ulcerative colitis.
Drug card
- Class
- TNF inhibitor
- How it works
- Binding TNF-alpha so it cannot activate its inflammatory receptors
- Used for
- Rheumatoid arthritis
- Plaque psoriasis and psoriatic arthritis
- Ankylosing spondylitis
- Crohn's disease
- Known for
- Serious infections, including invasive fungal ones
- Reactivation of latent tuberculosis
- Its name
- -mab means a monoclonal antibody; -umab means a fully human monoclonal antibody
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does adalimumab work?
Adalimumab is a recombinant, fully human IgG1 antibody that binds TNF-alpha specifically and stops it engaging its p55 and p75 receptors; it does not bind lymphotoxin (TNF-beta). In the presence of complement it also lyses cells that carry TNF on their surface, and it alters levels of the adhesion molecules that recruit leukocytes.
Like other TNF inhibitors: TNF-alpha is a cytokine that drives inflammation and tissue damage in rheumatoid arthritis, inflammatory bowel disease and psoriasis, partly by inducing IL-1, IL-6 and adhesion molecules that recruit leukocytes. These biologics bind soluble and membrane-bound TNF-alpha and stop it engaging its p55 and p75 receptors. Infliximab and adalimumab are monoclonal antibodies; etanercept is a soluble receptor fusion protein.
Uses
What is adalimumab used for?
- Rheumatoid arthritis
- Plaque psoriasis and psoriatic arthritis
- Ankylosing spondylitis
- Crohn's disease
- Ulcerative colitis
Side effects
Side effects of adalimumab
- Serious infections, including invasive fungal onesKnown forSerious
- Reactivation of latent tuberculosisKnown forSerious
- Injection-site redness, itching and pain
- Hepatitis B reactivationSerious
- Lymphoma, including hepatosplenic T-cell lymphomaSerious
- Non-melanoma skin cancerSerious
- New or worse heart failureSerious
- Demyelinating disease (multiple sclerosis, optic neuritis)Serious
- Lupus-like syndrome
- Low blood counts, rarely pancytopeniaSerious
- Severe skin reaction (Stevens-Johnson syndrome)Serious
- Heart attack or stroke (rare)Serious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Latent tuberculosis is tested for and treated before starting, and TB is watched for even after a negative test.
- Hepatitis B carriers are monitored during treatment and for several months after it.
- Not started during an active infection; live vaccines and use with anakinra or abatacept are avoided.
- Heart failure can start or worsen, so it is used with care in heart failure.
Good to know: Fully human and self-injected under the skin, unlike infliximab, a chimeric antibody given by intravenous infusion.
Remember it
A way to remember it
Check the two Bs before blocking TNF: TB and hepatitis B
TNF inhibitors can reactivate latent tuberculosis and hepatitis B, so both are screened for before the first dose and watched for during treatment.
Written for biofideX
Its name
-mab means monoclonal antibody
Older names show the source: -ximab chimeric, -zumab humanized, -umab human. WHO stopped adding that part in 2017 and dropped -mab in 2021; new names end in -tug, -bart, -ment or -mig.
-umab means fully human monoclonal antibody
Adalimumab, a TNF blocker made by phage display, is fully human. Read -umab only when no z comes before it: trastuzumab ends in -zumab and is humanized.
- Every drug name stem
Its class
TNF inhibitors
Other TNF inhibitors with a card:
Easily mixed up with CD20-targeted antibodies and aminosalicylates.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Targeted therapy and the immune system
Adalimumab is one of 13 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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