Adalimumab

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Adalimumab is recombinant monoclonal antibody directed against soluble human tumour necrosis factor alpha (TNF-α). Unlike infliximab, which is a chimeric mouse/human antibody, adalimumab is the recombinant human equivalent and should therefore not invoke an immune response.

Infliximab requires hospital supervision for doses, however adaluminab may be given at home. The drug remains interesting and requires adequate backup to deal with complications but the costs around administration may be usefully less than the chimeric antibody.

Contents

Indications

Anti-TNF antibody side effects

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  • Latent tuberculosis should be excluded[3]
  • Withdrawal of the anti-TNF therapy in a secondary lung malignancy that expressed TNF receptors lead to tumour regression[4]
  • Infections, including severe sepsis (odds ratio for serious infection 2.0 (95% CI, 1.3-3.1), number needed to harm 59 (95% CI, 39-125) within a treatment period of 3 to 12 months).
  • Malignancy (odds ratio for malignancy 3.3 (95% CI, 1.2-9.1) number needed to harm 154 (95% CI, 91-500) for 1 additional malignancy within period of 6 to 12 months), including an association with hepatosplenic T-cell lymphoma in patients also on mercaptopurines.

References to side-effects[5] [6]

References

  1. Hanauer et al. Human Anti-Tumor Necrosis Factor Monoclonal Antibody (Adalimumab) in Crohn's Disease: the CLASSIC-I Trial. Gastroenterology 2006
  2. Lovell DJ, Ruperto N, Goodman S, Reiff A, Jung L, Jarosova K, Nemcova D, Mouy R, Sandborg C, Bohnsack J, Elewaut D, Foeldvari I, Gerloni V, Rovensky J, Minden K, Vehe RK, Weiner LW, Horneff G, Huppertz HI, Olson NY, Medich JR, Carcereri-De-Prati R, McIlraith MJ, Giannini EH, Martini A. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. The New England journal of medicine. 2008 Aug 21; 359(8):810-20.(Link to article – subscription may be required.)
  3. Theis VS, Rhodes JM. Review article: minimizing tuberculosis during anti-tumour necrosis factor-alpha treatment of inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2008 Jan 1; 27(1):19-30.(Link to article – subscription may be required.)
  4. Lees CW, Wallace WAH, Satsangi J. Resolution of Non-small-Cell Lung Cancer after Withdrawal of Anti-TNF Therapy. NEJM 2008;359:320-1
  5. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA : the journal of the American Medical Association 2006;295(19):2275-85. (Direct link – subscription may be required.)
  6. Rosh JR, Gross T, Mamula P, Griffiths A, Hyams J. Hepatosplenic T-cell lymphoma in adolescents and young adults with Crohn's disease: A cautionary tale? Inflamm Bowel Dis 2007. (Direct link – subscription may be required.)

External links

  • UKMI 2003 review [1]
  • For RCTs regarding Adalimumab, click here.
  • For systematic reviews regarding Adalimumab, click here.
  • Search hubmed for papers from the BMJ/Lancet/NEJM/JAMA on Adalimumab
  • Search hubmed for Cochrane reviews on Adalimumab