Experiences with

Adalimumab

How to say adalimumab: AH-dah-lee-mu-mab.

Adalimumab is a biological medicine. This means it's made from proteins or other substances produced by the body. It's used to reduce swelling (inflammation) by acting on your immune system.

Adalimumab is used to treat inflammation of the:

• joints (rheumatoid arthritis, polyarticular juvenile idiopathic arthritis and active enthesitis-related arthritis)
• skin (plaque psoriasis and hidradenitis suppurativa)
• joints and skin (psoriatic arthritis)
• spine, causing back pain (axial spondyloarthritis and ankylosing spondylitis)
• gut and ulcers in the lining of the gut (Crohn's disease and ulcerative colitis)
• layer beneath the white of the eyeball (non-infectious uveitis)

Humira is the brand name of the original adalimumab medicine. There are now 5 newer versions of adalimumab, known by the brand names Amgevita, Hyrimoz, Idacio, Imraldi and Yuflyma.

These newer medicines are biosimilars. A biosimilar is a similar version of the original biological medicine. It works in the same way, by blocking part of your immune system to reduce inflammation.

If you switch, your body should respond the same way as if you'd stayed on Humira. You should not notice any difference.

Adalimumab is available on prescription. It comes as a pre-filled syringe or an injection pen that you inject under the skin. If you're switching from Humira to a different brand of adalimumab, the way the injection pen or syringe works might be different.

As long as you have no symptoms of COVID-19 infection, carry on taking your prescribed immunosuppressant medicine as usual.

If you develop any COVID-19 symptoms, talk to your specialist doctor urgently. They will tell you if you need to stop treatment until these symptoms get better.

Updated: 20 March 2020

Who can take adalimumab

Most adults aged 18 years and over can take adalimumab. It may be suitable for some children.

Adalimumab is not suitable for some people.

To make sure this medicine is safe for you, tell your specialist if you:

• have ever had an allergic reaction to adalimumab or any other medicine
• have an infection or a high temperature, or feel unwell
• have ever had tuberculosis (TB), or been in contact with someone with it
• have heart failure
• have hepatitis B
• have a nervous system condition, including multiple sclerosis, optic neuritis or Guillain-Barré syndrome
• have ever had cancer
• are about to have surgery or a dental procedure
• are pregnant or trying to get pregnant
• are allergic to latex – the Amgevita injection pen is not latex-free

Dosage

Adalimumab is a prescription medicine. It's important to take it as advised by your specialist.

For adults, dosages and how often you take it depends on your condition:

• plaque psoriasis – the usual starting dose is 80mg, then 40mg after a week and then 40mg, taken every 2 weeks
• rheumatoid arthritis – the usual dose is 40mg, taken every 2 weeks. You can take it weekly, or 80mg every 2 weeks, if you're not taking any other medicine for rheumatoid arthritis
• psoriatic arthritis, axial spondyloarthritis or ankylosing spondylitis – the usual dose is 40mg, taken every 2 weeks
• Crohn's disease – the usual starting dose is 80mg and then 40mg, taken every 2 weeks. It can be taken weekly if needed or 80mg every 2 weeks. If you need a higher dose, you can start with 160mg, then 80mg after 2 weeks and then 40mg every 2 weeks
• ulcerative colitis – the usual starting dose is 160mg, then 80mg after 2 weeks and then 40mg, taken every 2 weeks. It can be taken weekly if needed or 80mg every 2 weeks
• hidradenitis suppurativa – the usual starting dose is 160mg, then 80mg after 2 weeks and then after another 2 weeks you can take 40mg every week or 80mg every 2 weeks
• non-infectious uveitis – the usual starting dose is 80mg, then 40mg after a week and then 40mg, taken every 2 weeks

For children, dosages are usually based on their weight. How often they take it depends on their condition:

• plaque psoriasis – after the first dose, doses are given after 1 week, and then every 2 weeks
• juvenile idiopathic arthritis – after the first dose, doses are usually given every 2 weeks
• enthesitis-related arthritis – doses are given every 2 weeks
• Crohn's disease – after the first dose, doses are given every 2 weeks. It can be given weekly if needed
• non-infectious uveitis – after the first dose, doses are given after 1 week, and then every 2 weeks. It can be given every 2 weeks from the first dose
• adolescent hidradenitis suppurativa (from 12 years) – the usual starting dose is 80mg, then 40mg after one week and then 40mg every 2 weeks. It can be given weekly if needed or 80mg every 2 weeks
• ulcerative colitis – after the first dose, doses are given every 2 weeks

When you start taking adalimumab you'll be given a patient alert card. Carry this with you all the time.

It tells healthcare professionals that you're taking adalimumab. This can be useful for them to know in case of a medical emergency.

If you do not have a patient alert card, you can ask your specialist for one.

Your adalimumab medicine will be delivered to your home by a homecare provider.

A homecare support nurse will show you how to use the injection so you can give yourself or your child the injection at home.

You'll need to store the injections in your fridge.

Biosimilar injections

If you're switching from Humira to an adalimumab biosimilar, the way the injection works might be different.

You can ask your specialist, homecare support nurse or pharmacist for training on the new injection if you need it.

Biosimilar syringes

There's not much difference between the Humira syringe and other biosimilar syringes.

The Humira, Amgevita and Yuflyma syringes come with a needle shield.

The Hyrimoz, Idacio and Imraldi syringes have a retracting needle, where the needle goes back into the main part of the syringe once the injection has finished.

A needle shield or retractable needle helps reduce the risk of accidental needle injuries.

Biosimilar injection pens

There's not much difference between the Humira injection pen and other biosimilar pens.

All the injection pens start with a loud click and have a small window on the injection, which changes colour when the injection has finished.

You may hear a second click with the Amgevita, Hyrimoz, Imraldi and Yuflyma pens. This means your injection is almost done.

If you forget your dose

If you forget to give yourself an injection, inject the dose as soon as you remember. Then take your next dose on the original scheduled day.

If you do not remember until close to the day of your next dose, speak to your specialist. They'll let you know whether to skip the missed dose.

If you take too much

• you have taken more than your prescribed dose of adalimumab

Go to 111.nhs.uk or call 111

Have the medicine packet or leaflet inside it, plus any remaining medicine, with you.

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Common side effects

These common side effects of adalimumab happen in more than 1 in 10 people. There are things you can do to help cope with them:

You might get side effects up to 4 months after you stop taking adalimumab.

Speak to your doctor if you get any side effects.

Serious side effects are uncommon and affect less than 1 in 100 people.

Tell your doctor or contact 111 if:

• you get infections, including a high temperature, chills, increased sweating, feeling unwell or more tired than normal, diarrhoea, coughing up blood or mucus, shortness of breath, problems peeing, skin sores, wounds or muscle aches – these could be signs of a severe infection
• you have shortness of breath, or swelling of your ankles or feet – these could be signs of heart failure
• you have night sweats, swollen glands (lymph nodes) in your neck, armpits, groin or other areas, weight loss, changes to your skin, such as lumps or sores (skin lesions), changes to moles or freckles you already have, or severe itchiness that cannot be explained – these could be signs of cancer
• you have numbness or tingling, vision changes, muscle weakness, or unexplained dizziness – these could be signs of nervous system problems
• you have a persistent high temperature, bruising, or you bleed very easily – these could be signs of a blood disorder
• your symptoms get worse or you have unexplained symptoms – these could be signs of autoimmune conditions

Go to 111.nhs.uk or call 111.

Serious allergic reaction

In rare cases, adalimumab may cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of adalimumab. For a full list, see the leaflet inside your medicine packet.

Adalimumab and pregnancy

You can take adalimumab during pregnancy, especially if it's needed to keep you well.

Talk to your doctor if you become pregnant or are thinking of becoming pregnant while taking adalimumab. They will help you weigh up the benefits and possible risks so you can decide on the best treatment plan for you.

Do not stop taking your medicine unless your doctor tells you to. You may need to continue to take adalimumab during pregnancy to stay healthy and well.

If your doctor or midwife says your baby is healthy you can take adalimumab while you're breastfeeding.

Adalimumab passes into breast milk in tiny amounts and your baby will not absorb a lot into their body from the breast milk. It has not been known to cause side effects in breastfed babies.

If your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife as soon as possible.

After your baby is born

If you're taking adalimumab while pregnant, your baby will not be able to have live vaccines for the first six months after they're born.

This means that they will not be able to have the rotavirus vaccination (which must be given by 4 months of age). The BCG vaccine (if needed) will have to be delayed. All of the other early vaccinations can be given as normal.

Adalimumab and fertility

There's no evidence to suggest that taking adalimumab reduces fertility in either men or women.

Speak to your doctor if you're trying to get pregnant. They may want to review your treatment.

Cautions with other medicines

Do not take adalimumab with medicines that can increase the risk of serious infections, including:

• live vaccinations – some vaccines use live viruses – these include measles, mumps and rubella (MMR), BCG, rotavirus, some shingles vaccines and some flu vaccines. If you need a vaccine always check with your doctor or pharmacist whether it is suitable for you
• abatacept, a medicine to treat autoimmune diseases
• anakinra, a medicine to treat rheumatoid arthritis

There's not enough information to say that herbal remedies or supplements are safe to take with adalimumab. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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