Adalimumab

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

Adalimumab is a biological medicine. It's used to reduce inflammation by acting on your immune system.

Humira is the brand name of the original adalimumab medicine. There are now 4 new versions of adalimumab.

Brand names include Amgevita, Imraldi, Hyrimoz and Hulio. More brands are likely to be available at the end of 2019.

These new medicines are biosimilars. A biosimilar is a similar version of an original biological medicine.

Adalimumab biosimilars are equally safe and effective in reducing inflammation as Humira (the original adalimumab medicine).

All versions of adalimumab are 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, including ankylosing spondylitis)
• gut and ulcers in the lining of the gut (Crohn's disease and ulcerative colitis)
• the layer beneath the white of the eyeball (non-infectious uveitis)

Adalimumab is available on prescription. It comes as a pre-filled syringe or injection pen that you inject under the skin.

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

You'll be shown how to use the injection by a homecare support nurse so you can give yourself or your child the injection at home.

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

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.

If there are any changes to your homecare provider, you'll be told before any changes are made.

• Adalimumab is known by the brand names Humira, Amgevita, Imraldi, Hyrimoz and Hulio.
• Adalimumab biosimilars are just as safe and effective as Humira.
• It takes a few weeks for Humira and adalimumab biosimilars to work. It may take longer depending on your condition.
• They work by blocking part of your immune system to reduce inflammation.
• If you're switching from Humira to a different brand of adalimumab, the way the injection pen or syringe works might be different.

Adalimumab can be used by adults, and some brands can be used by children.

Adalimumab is not suitable for some people.

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

• have had an allergic reaction to adalimumab or any other medicines in the past
• have an infection or a fever, or feel unwell
• have or have had tuberculosis, or been in contact with someone with it
• have heart failure
• have hepatitis B
• have a nervous system disease, including multiple sclerosis, optic neuritis and Guillain-Barré syndrome
• have or have had cancer
• are about to have surgery or a dental procedure
• are pregnant or trying to get pregnant - it's best to use contraceptives and continue to use them for at least 5 months after your last adalimumab treatment
• are allergic to latex - the Hyrimoz syringe and injection pen and Amgevita injection pen are not latex-free

Adalimumab comes as a pre-filled syringe or injection pen.

You'll be shown how to use the injection by a specialist nurse, pharmacist or homecare support nurse so you can give yourself or your child the injection at home.

Dosages

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 every 2 weeks.
• rheumatoid arthritis - the usual dose is 40mg every 2 weeks. It can be taken weekly if you're not taking any other medicine for rheumatoid arthritis.
• psoriatic arthritis, axial spondyloarthritis, including ankylosing spondylitis - the usual dose is 40mg every 2 weeks.
• Crohn's disease - the usual starting dose is 80mg and then 40mg every 2 weeks. It can be taken weekly if needed. If you need a higher dose, you can start with 160mg, 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 every 2 weeks.
• hidradenitis suppurativa - the usual starting dose is 160mg, then 80mg after 2 weeks and then 40mg after another 2 weeks, then 40mg every week.
• non-infectious uveitis - the usual starting dose is 80mg, then 40mg after a week and then 40mg 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, the next dose is given after 1 week, and then every other week.
• juvenile idiopathic arthritis - after the first dose, doses are usually given every other week. It can be given weekly if needed.
• enthesitis-related arthritis - doses are given every other week.
• Crohn's disease - after the first dose, doses are normally given every other week. It can be given weekly if needed.
• non-infectious uveitis - after the first dose, doses are given after 1 week, and then every other week.

What if I forget my dose?

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

If it's close to the day of your next dose, speak to your specialist. They'll let you know whether to skip the missed dose.

What if I take too much?

Call your doctor or specialist if you have accidentally taken too much.

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

Common side effects

Common side effects happen in more than 1 in 10 people:

• pain, swelling, redness or itchy skin where your injection was given
• a mild nose, throat or sinus infection
• a headache
• stomach pains, feeling or being sick
• a rash
• muscle or bone pains

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

Speak to your specialist if you experience any side effects.

Serious side effects

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

You should tell your specialist or doctor if you experience:

• infections, including a fever, chills, unusual sweating, feeling unwell or more tired than normal, diarrhoea, coughing up blood or mucus, shortness of breath, problems urinating, skin sores, wounds or muscle aches - these could be signs of a severe infection
• shortness of breath, swelling of your ankles or feet - these could be signs of heart failure
• night sweats, swollen glands (lymph nodes) in the 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, severe itchiness that cannot be explained - these could be signs of cancer
• numbness or tingling, vision changes, muscle weakness, unexplained dizziness - these could be signs of nervous system problems
• persistent fever, bruising, very easy bleeding - these could be signs of a blood disorder
• worsening symptoms or unexplained symptoms - these could be signs of autoimmune conditions

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.

What to do about:

• pain, swelling, redness or itchy skin where your injection was given - take the syringe or pre-filled pen out of the fridge and leave at room temperature for 15 to 30 minutes before injecting. Do not warm it in any other way. Choose a different area of skin each time you give yourself an injection. These symptoms are usually mild and should only last a few hours. You can ask a pharmacist to recommend a mild painkiller if the pain is bothering you.

• mild nose, throat or sinus infection - rest and drink plenty of water. Speak to your pharmacist. They may recommend medicines to relieve your symptoms, such as a nasal spray. Speak to your doctor for advice if your symptoms get worse.

• headache - rest and drink plenty of water. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Speak to your doctor if your headaches last longer than a week or get worse.

• stomach pains, feeling or being sick - try to rest and relax. It can help to eat and drink slowly and have smaller, more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. Stick to simple meals and do not eat rich or spicy food. If you're being sick, try having small, frequent sips of water. If you're in a lot of pain, speak to your pharmacist or doctor.

• muscle or bone pain - speak to your pharmacist about painkillers for mild to moderate pain. If you're in a lot of pain, speak to your specialist or doctor as soon as possible in case these are signs of a serious side effect.

It's not known if adalimumab is safe to use during pregnancy.

If you become pregnant while taking adalimumab, speak to your specialist about the benefits and possible risks.

For more information about how adalimumab can affect you and your baby during pregnancy, read the leaflet about the best use of medicines in pregnancy (BUMPS).

Adalimumab and breastfeeding

Adalimumab is thought to be safe to use while breastfeeding.

It passes into breast milk, but only in small amounts that are not harmful to the baby.

After your baby is born

If you're taking adalimumab while pregnant, your baby may be at a higher risk of getting an infection once they're born.

Speak to your doctor or midwife, as they may delay giving your baby live vaccines until they're at least 6 months old to avoid any risks of infection.

You should not take adalimumab with medicines that can increase the risk of serious infections:

• live vaccination - some vaccines use live viruses; for example, measles mumps and rubella (MMR), shingles and some flu vaccinations
• abatacept - a medicine to treat autoimmune diseases
• anakinra - a medicine to treat rheumatoid arthritis