Adalimumab

How it works

It binds and neutralises tumour necrosis factor alpha, preventing its interaction with cell-surface receptors and reducing the inflammatory cascade driving these diseases.

Prescribing in practice

• Screen for and treat latent tuberculosis and check hepatitis B status before starting, as TNF inhibition can reactivate serious infections.
• Avoid initiating during active serious infection and use with caution in heart failure and in patients with a history of demyelinating disease.
• Live vaccines should be avoided during treatment; bring immunisations up to date beforehand where possible.

Monitoring

Monitor for signs of infection and tuberculosis reactivation throughout treatment, and review periodically for malignancy risk and disease response.

Counselling the patient

• Report fever, persistent cough, weight loss or night sweats, which may indicate infection or tuberculosis.
• Avoid live vaccines and tell other clinicians you are on a biologic; carry your alert card.
• Store the injection in the fridge and follow training on self-injection technique and sharps disposal.

Evidence & guidelines

NICE technology appraisals support adalimumab across several inflammatory conditions after inadequate response to conventional therapy.