Adalimumab (Humira)

Indications

  • xxx

Pharmacology

Metabolism

  • xxxx

Administration

  • SQ

Dose Adjustment

  • Hepatic:
  • Renal:

General Adverse Effects of Anti-Tumor Necrosis Factor-α (Anti-TNFα) Therapy

Dermatologic Adverse Effects

Erythema Multiforme (see Erythema Multiforme, [[Erythema Multiforme]])

  • xxx

Infectious Adverse Effects

  • Aspergillus (see Aspergillus, [[Aspergillus]])
    • Invasive Pulmonary Aspergillosis (see Aspergillus, [[Aspergillus]])
  • Blastomyces (see Blastomycosis, [[Blastomycosis]]): case report of 3 cases
  • Candida (see Candida, [[Candida]])
    • Candida Esophagitis
    • Candidemia
    • Oropharyngeal Thrush
  • Coccidioides Immitis (see Coccidioidomycosis, [[Coccidioidomycosis]])
  • Cryptococcus (see Cryptococcosis, [[Cryptococcosis]]): 28 published cases
  • Histoplasma (see Histoplasmosis, [[Histoplasmosis]])
  • Legionella (see Legionellosis, [[Legionellosis]]): case series of 10 patients
  • Listeriosis (see Listeriosis, [[Listeriosis]]): case series of 15 patients
  • Mycobacterium Tuberculosis (see Tuberculosis, [[Tuberculosis]])
  • Pneumocystis Jirovecii (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
  • Strongyloides (see Strongyloidiasis, [[Strongyloidiasis]]): 1 case report
  • Viral Upper Respiratory Infections (however, there is no increased risk of viral pneumonias)

Pulmonary Adverse Effects

Accelerated Progression of Rheumatoid Lung Nodules (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]])

  • Epidemiology
    • Etanercept (Enbrel) (see Etanercept, [[Etanercept]]): may accelerate progression of rheumatoid lung nodules

Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])

  • Epidemiology
    • Infliximab (Remicade) (see Infliximab, [[Infliximab]])

Granulomatous Lung Disease (see Granulomatous Lung Disease, [[Granulomatous Lung Disease]])

  • Epidemiology
    • Etanercept (Enbrel) (see Etanercept, [[Etanercept]]): can cause a pneumonitis with non-necrotizing granulomas and lymphohistiocytic infiltrates
    • Infliximab (Remicade) (see Infliximab, [[Infliximab]]): can cause a pulmonary “bronchiocentric allergic granulomatosis” (observed in a patient with ankylosing spondylitis)

Interstitial Lung Disease (ILD) (see Interstitial Lung Disease, [[Interstitial Lung Disease]])

  • Epidemiology
    • Etanercept (Enbrel) (see Etanercept, [[Etanercept]]): may worsen pre-existing RA-associated interstitial lung disease
    • Infliximab (Remicade) (see Infliximab, [[Infliximab]])
      • May worsen pre-existing RA-associated interstitial lung disease
      • Addition of infliximab can precipitate methotrexate pneumonitis (see Methotrexate, [[Methotrexate]])
    • Adalimumab (Humira) (see Adalimumab, [[Adalimumab]]): interstitial lung disease has been reported

Pulmonary Infiltrates with Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])

  • Epidemiology
    • Infliximab (Remicade) (see Infliximab, [[Infliximab]])

Renal Adverse Effetcs

Acute Interstitial Nephritis (see Acute Interstitial Nephritis, [[Acute Interstitial Nephritis]])

  • Epidemiology: associated with etanercept

Rheumatologic Adverse Effects

Accelerated Progression of Rheumatoid Lung Nodules (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]])

  • Epidemiology
    • Etanercept (Enbrel) (see Etanercept, [[Etanercept]]): may accelerate progression of rheumatoid lung nodules

Drug-Induced Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]])

  • Epidemiology
    • Adalimumab (Humira) (see Adalimumab, [[Adalimumab]])
    • Etanercept (Enbrel) (see Etanercept, [[Etanercept]])
    • Infliximab (Remicade) (see Infliximab, [[Infliximab]])

References

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  • Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Ann Intern Med 1999; 130:478-486
  • Infliximab (chimeric anti-tumor necrosis factor-alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet 1999; 354:1932-1939
  • Tumor necrosis factor alpha antibody (infliximab) therapy profoundly downregulates the inflammation in Crohn’s ileocolitis. Gastroenterology 1999; 116:22-28
  • Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345:1098-1104
  • Cell-mediated immunity to Histoplasma capsulatum. Semin Respir Infect 2001; 16:102-108
  • Life-threatening histoplasmosis complicating immunotherapy with tumor necrosis factor-alpha
    antagonists infliximab and etanercept. Arthritis Rheum 2002; 46:2565-2570
  • Methotrexate pneumonitis after initiation of infliximab therapy for rheumatoid arthritis. Arthritis Rheum 2002; 47:670-671
  • Delayed hypersensitivity reaction and acute respiratory distress syndrome following infliximab infusion. Inflamm Bowel Dis 2002; 8:186-191 [MEDLINE]
  • Accelerated nodulosis and vasculitis following etanercept therapy for rheumatoid arthritis. Arthritis Rheum 2002; 47:445-449 [MEDLINE]
  • Methotrexate pneumonitis after initiation of infliximab therapy for rheumatoid arthritis. Arthritis Rheum 2002; 47:670-671
  • Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002; 359:1187-1193
  • Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 2002; 46:2287-2293
  • Accelerated nodulosis and vasculitis following etanercept therapy for rheumatoid arthritis. Arthritis Rheum 2002; 47:445-449
  • Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002; 359:1187-1193
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  • Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis 2003; 3:148-155
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  • Histoplasmosis after treatment with anti-tumor necrosis factor-alpha therapy. Am J Respir Crit Care Med 2003; 167:1279-1282
  • Granulomatous infections and tumor necrosis factor-antagonist therapies. Abstract (# THU0209) presented at: Proceedings of the Annual European Congress of Rheumatology European League Against Rheumatism; June 18-21, 2003; Lisbon, Portugal.
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  • Tumor necrosis factor-alpha blockade for the treatment of acute GVHD. Blood 2004; 104:649-654
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  • New drugs for rheumatoid arthritis. N Engl J Med 2004; 350:2167-2179
  • Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis 2004; 38:1261-1265
  • Effects of infliximab on apoptosis and reverse signaling of monocytes from healthy individuals and patients with Crohn’s disease. Inflamm Bowel Dis 2004; 10:801-810
  • Pneumocystis carinii pneumonia with oral candidiasis after infliximab therapy for Crohn’s disease. Dig Dis Sci 2004; 1458- 1460
  • Fatal exacerbation of rheumatoid arthritis associated fibrosing alveolitis in patients given infliximab. BMJ 2004; 329:1266
  • Interstitial pneumonitis associated with infliximab therapy. J Rheumatol 2006; 33:1189-1193
  • Pulmonary lymphohistiocytic reactions temporally related to etanercept therapy. Mod Pathol 2005; 18:651-655
  • Clinical pharmacokinetics of TNF antagonists: how do they differ? Semin Arthritis Rheum 2005; 34:12-18
  • Tuberculosis associated with therapy against tumor necrosis factor-alpha. Arthritis Rheum 2005; 52:2968- 2974
  • Infections associated with tumor necrosis factor-alpha antagonists. Medicine 2005; 84:291-302
  • Pulmonary lymphohistiocytic reactions temporally related to etanercept therapy. Mod Pathol 2005; 18:651-655
  • Pulmonary complications of infliximab therapy in patients with rheumatoid arthritis. J Rheumatol 2006; 33:622-628
  • Tumor necrosis factor blockers: differential effects on mycobacterial immunity. J Infect Dis 2006; 194:486-492
  • Safety analyses of adalimumab (HUMIRA) in global clinical trials and US postmarketing surveillance of patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65:889-894
  • Emergence of Legionella pneumophila pneumonia in patients receiving tumor necrosis factor- alpha antagonists. Clin Infect Dis 2006; 43:e95-e100
  • Pulmonary complications of infliximab therapy in patients with rheumatoid arthritis. J Rheumatol 2006; 33:622-628
  • Interstitial pneumonitis associated with infliximab therapy. J Rheumatol 2006; 33:1189-1193
  • Development of active tuberculosis following initiation of infliximab despite appropriate prophylaxis. Rheumatology (Oxford) 2007; 46:887-888
  • Pneumocystis jiroveci (carinii) pneumonia after infliximab therapy: a review of 84 cases. Dig Dis Sci 2007; 52:1481-1484
  • Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis. Ir J Med Sci 2007; 176:309-311
  • Pneumocystis carinii pneumonia in a rheumatoid arthritis patient treated with adalimumab. Scand J Infect Dis 2007; 39:475-478
  • Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis after anti-TNF-alpha therapy. J Clin Rheumatol 2007; 13:150-152
  • Fungal infections complicating tumor necrosis factor-alpha blockade therapy. Mayo Clin Proc 2008; 83:181-194
  • Acute interstitial nephritis associated with etanercept. Rheumatol Int 2008;28:1283-4
  • Rheumatology (Oxford). 2009 Jul;48(7):716-20. Epub 2009 May 4
  • Adalimumab-induced interstitial pneumonia with an improvement of pre-existing rheumatoid arthritis-associated lung involvement. Intern Med. 2011;50(7):749-51