Adalimumab

introduction

Adalimumab is a drug that belongs to the class of biologicals and can be used primarily for autoimmune diseases.
In these diseases, our natural defense system overreacts and attacks the body's own cells.
For example, adalimumab can be used in patients who e.g. suffer from psoriasis, rheumatism or chronic inflammatory bowel disease, take remedial action.

In the following you can find out more about the areas of application, the effects and also side effects of adalimumab.

What are biologics?

The pharmaceutical class of biologicals refers to artificially produced proteins that can specifically intervene in the function of our immune system.
This can slow down overreactions against the body's own tissue and alleviate the course of the disease.

These proteins produced with the help of biotechnology are very similar to our own proteins and therefore rarely lead to side effects such as allergies.
Today they are considered to be one of the most important development approaches in pharmacotherapy and meanwhile help many patients with autoimmune diseases or cancer.

You can find more detailed information about biologics in our article: Biologics

Indications

Adalimumab is used in many different autoimmune diseases.
What all diseases have in common is that our natural defense system is overreactive and attacks the body's own cells.
Adalimumab can modulate our immune system and thus reduce this malfunction.

Adalimumab is currently only a second-line drug due to its complexity and cost, but it can be used for non-treatable diseases. These include:

• rheumatoid arthritis (an inflammatory disease that mainly affects the small joints)
• the inflammatory bowel diseases Crohn's disease and ulcerative colitis,
• ankylosing spondylitis (also called ankylosing spondylitis) and
• the skin disease psoriasis (psoriasis).

Use in Crohn's disease

Crohn's disease is a chronic inflammatory bowel disease that mainly affects adolescents and young adults and has no tangible cause.
The disease manifests itself primarily through chronic diarrhea, abdominal pain and painful bowel movements, as well as weight loss, growth disorders and anemia due to the reduced absorption of nutrients via the intestine.

Numerous symptoms outside the gastrointestinal tract can also occur, such as Inflammation of the joints or eyes.
Since a hypersensitive immune system is responsible for the damage in Crohn's disease, the therapy works with substances that shut down the immune system.
These include above all the so-called glucocorticoids such as Cortisone.
If the disease does not respond adequately to cortisone therapy or if high amounts of glucocorticoids are required with corresponding side effects, biologicals - including adalimumab - can be used to contain the disease.
Adalimumab can be combined with other drugs.

Application ankylosing spondylitis

Bechterew's disease is a chronic, inflammatory disease that can lead to complete stiffening of the spine.
The inflammation is caused by an overly sensitive immune system, similar to, for example, chronic inflammatory bowel diseases.
This means that the body's own immune cells attack not only pathogens, but also the joints of the spine.
The damage occurring here can lead to the destruction of the architecture of the spine and thus to glorifying restricted mobility.
To counteract the stiffening of the spine, the most important pillar of therapy is physiotherapy and physiotherapy.

Medicinally, anti-inflammatory painkillers such as Ibuprofen or the so-called glucocorticoids (cortisone) can be helped in acute attacks.
In addition, studies have shown that biologicals such as adalimumab can have a positive effect on the development of the disease.
By regulating the immune system, the progress of the disease can be slowed down.

Here, however, the biologicals are so-called reserve medications and are only prescribed if therapy with physiotherapy and pain medication fails, also because of the high price and possible side effects.

Use in psoriasis

Psoriasis, better known as psoriasis, is an inflammatory disease that primarily affects the skin, but can often also affect joints and internal organs.
The development of psoriasis is caused by many different factors, but here, too, an overly sensitive immune system is involved in the disease process. Adalimumab is also used as a biological in psoriasis as a reserve when first-line therapy fails.
Here, the psoriasis must be very pronounced and associated with a high level of suffering or have affected the patient's joints.
By regulating the immune system, adalimumab can have a positive influence on the development of the disease.

Active ingredient / effect of adalimumab

Adalimumab belongs to the so-called biologicals, a group of relatively new drugs that have a regulatory influence on our body's immune system. More precisely, adalimumab is one of the so-called tumor necrosis factor-alpha inhibitors, which are generally used for chronic inflammatory, systemic - that is, the whole body - diseases in which the standard therapy has failed.

Adalimumab inhibits the body's own messenger substance tumor necrosis factor alpha, which is involved in the development of inflammation.
Inflammations are used, for example, when pathogens penetrate, to kill them and prevent them from spreading into the body's circulation.
This can prevent serious infections from our immune system, even if some of the body's own cells perish.
However, it can happen that our immune system is dysregulated and not only sees foreign cells as a threat, but also the body's own cells.
If these are then attacked by our immune system, inflammation occurs and this leads to the destruction of cells.
In the case of rheumatic diseases, for example, this can lead to the destruction of joints with severe pain and restricted mobility.

Here adalimumab can intervene in the development of the inflammation by inhibiting one of the messenger substances and thus reducing the inflammatory activity.
In this way, the body's own healthy cells can be preserved and the progression of chronic inflammatory diseases slowed down.

These are possible side effects

Adalimumab is a drug that is associated with numerous serious side effects.
The most important side effect is related to the mode of action: The body's own defense system is inhibited by adalimumab - this is also referred to as immunosuppression.
This effect is certainly desirable in the case of chronic inflammatory diseases, which are caused by the hypersensitivity of the immune system to the body's own cells, but it also means that one's own defense against pathogens is reduced.

Patients are more likely to develop viral or bacterial infections which, due to the weakened immune system, can also lead to increased complications such as pneumonia or blood poisoning (sepsis).

If patients have an inactive and symptom-free tuberculosis infection, this can be reactivated while taking adalimumab.

In addition to defending against pathogens, the immune system is also responsible for fighting tumor cells.
It detects abnormal cells every day (i.e. cells that suddenly start to divide excessively due to defects and can lead to cancer) and destroy them before a tumor can develop. However, since adalimumab suppresses the immune system, patients are at an increased risk of cancer to get sick.

Adalimumab also affects the formation of blood cells.
Taking it can lead to a decrease in red and white blood cells (known as anemia and leukopenia).
The number of blood platelets (thrombocytes), which are responsible for blood clotting, can also drop.
The result is an increased tendency to bleed.

Side effects on the gastrointestinal tract such as nausea, abdominal pain and vomiting are also known.
Headache, joint pain and muscle pain are also described.
Finally, as with any medication, allergic reactions can occur when taking adalimumab.

Does taking adalimumab lead to weight gain?

Many patients wonder if they will gain weight while taking adalimumab.
Often the patients have previously taken cortisone, which is known for increased appetite and therefore often weight gain.

Officially, no weight gains are listed in the side effects for adalimumab.
Many patients report that they have been able to lose weight again by reducing the dose of cortisone through the use of adalimumab.

It should be noted, however, that adalimumab can lead to water retention, so-called edema.
The scales show more weight, but it is only water and not fat.

Does adalimumab cause depression?

Adalimumab is a drug with many possible side effects, which can occur but are by no means pronounced in every patient.
The patient information leaflet for adalimumab lists mood swings as common (affects 1 in 10 people), which can also include depression.

If you notice prolonged episodes of loss of interest, sadness or exhaustion during the therapy, you should not be afraid to talk to your doctor about it and, if necessary, treat a possible depressive episode in good time.

You can read about the symptoms by which you could recognize a possible depression in our appropriate articles:

How can you recognize depression? as well as symptoms of depression

Adalimumab and hair loss

Hair loss is also one of the more common side effects of adalimumab.
The severity of hair loss is very different.
If you notice the onset of hair loss, it is also advisable to talk to the treating doctor about it so that he can clarify the exact cause and treatment options can be discussed.

If you want to know how hair loss can be treated, then read more about this topic in our article: Hair Loss Treatment

These are the interactions of adalimumab

Almost no interactions are known for adalimumab.
In particular, drugs such as anticoagulants (e.g. Marcumar), which often lead to interactions, go well with adalimumab.

Some studies have shown that the combination of adalimumab with other biologicals or anti-inflammatory drugs can weaken the effect of adalimumab or can greatly increase the patient's susceptibility to infections.
It is therefore important that you take your medication strictly according to the instructions of your treating doctor.
In addition, you should always tell your doctor about newly prescribed or privately purchased drugs so that he can keep an eye on the interactions.

Adalimumab contraindications

There are some contraindications for adalimumab, also known as contraindications, which make the use of adalimumab impossible. First of all, this includes a known allergy to adalimumab, as this can lead to a strong allergic reaction up to anaphylactic shock when ingested, which can also be fatal.

In addition, adalimumab must not be used if the patient has tuberculosis.
Both active tuberculosis (i.e. symptomatic) and symptom-free, so-called latent tuberculosis count here, as this can be reactivated when the immune system is suppressed.
Adalimumab must also not be used in cases of moderate to severe cardiac insufficiency, as this can worsen.
These include stages NYHA III and IV.

In addition to these absolute contraindications, which completely prohibit the use of adalimumab, there are also many relative contraindications for which adalimumab may only be used under strict risk-benefit assessment and monitoring.
These include e.g. Liver disease, central nervous system disease, or tumor disease.

How is adalimumab dosed?

The dosage of adalimumab is individual, may only be determined by a suitably qualified specialist and should be strictly followed.
Adalimumab is taken as an injection and injected under the skin (subcutaneously).

In most cases, the application is only necessary once a week or less and the amount of the active ingredient can be adjusted during the course of therapy.

Why is the cost so high?

Biologicals are still relatively new drugs.
Their production is extremely complex and requires many individual steps in high-tech laboratories.
As a result, the costs for biologicals, which can also only be used in syringe form, are very high.
However, costs have been falling in recent years as better and less complicated manufacturing methods are explored.

A further development of the price remains to be seen.

Adalimumab and alcohol - are they compatible?

No interaction between adalimumab and alcohol consumption is indicated in the package insert for adalimumab.
Since adalimumab is administered as a syringe, it cannot interfere with absorption in the gastrointestinal tract.

However, alcohol should generally be discouraged in the event of acute attacks of a chronic inflammatory disease, as it also puts our body under stress and has a negative effect on the immune system.
For example, flare-ups from alcohol consumption can be longer and more severe.

Alternative medicines to Humira

Humira is the trade name of adalimumab, similar to e.g. Acetylsalicylic acid is sold under the name Aspirin.
Adalimumab is generally not a first-line therapy for chronic inflammatory diseases and is often only prescribed when conventional therapy has failed.
Since the diseases in which Humira is used vary widely and show very variable characteristics and symptoms depending on the patient, no general alternative to Humira can be recommended.
For example, other biologicals from the range of tumor necrosis factor-alpha inhibitors such as Etanercept come into use.

In some cases, anti-inflammatory pain relievers such as ibuprofen or diclofenac may also be sufficient to improve the symptoms.
This decision should be made by an experienced specialist.

You can find more detailed information on the treatment of the individual diseases on the following pages:

• Therapy of Crohn's disease
• Therapy of ankylosing spondylitis
• Therapy of psoriasis (psoriasis)

Can be taken during pregnancy and breastfeeding?

It is currently not recommended to take adalimumab during pregnancy.
For ethical reasons, there are no human studies that can prove or rule out a harmful effect on the unborn child, but it is assumed that adalimumab has an effect on the development of the child's immune system.
For example, women of childbearing potential who take adalimumab are advised to use contraception.
If pregnancy occurs, the intake should be stopped immediately and the attending doctor should be consulted.

It is also not advisable to take adalimumab while breastfeeding, as the active ingredient can pass into the newborn through breast milk.
It is recommended to start breastfeeding no earlier than 5 months after the last dose.

Do you want to have children during therapy with adalimumab?

Pregnancy is not recommended while taking adalimumab.
This means that patients wishing to have children should consult their treating doctor to change their current therapy and discontinue adalimumab.
In order to avoid a worsening of the disease, this should never be decided on your own, but only after consultation and therapy change with the doctor!

Adalimumab and pill - is that possible?

There are no known interactions between adalimumab and the birth control pill.
This means that the effects of the pill will not be affected by adalimumab.
Since pregnancy is not recommended as part of adalimumab therapy, the pill would even be an effective method of contraception.