Adalimumab Flashcards
What is the name of the class which adalimumab belongs to?
Immunomodifiers
biologicals
What is adalimumab indicated for?
rheumatoid arthritis polyarticular juvenile idiopathic arthritis psoriatic arthritis ankylosing spondylitis crohn's disease chronic plaque psoriasis
What is adalimumab?
it is a biological or form of monoclonal antibody against TNF alpha. It has no foreign components so tends to be more tolerated than infliximab which contains some murine components.
How is adalimumab taken?
self administered once a fortnight by subcutaneous injection.
40mg/fortnight
What is the mechanism of action of adalimumab?
Binds to TNF alpha, blocking interaction with p55 and p75 cell surface TNF receptors (prevents activation of cells), preventing inflammation and tissue destruction.
Also modulates biological responses induced/regulated by TNF (e.g. changes in levels of adhesion molecules responsible for leukocyte migration)
What are some precautions associated with adalimumab?
immunocomprised patient - predisposition to infection.
demyelinating CNS disorders in patients - at risk of exacerbation
mild heart failure - discontinue if symptoms develop/worsen
history of malignant development - monitor for non
melanoma skin cancer before and during treatment
Pregnancy Class C: avoid. effective contraception required during treatment and for at least 5 months after last dose
Take caution in breastfeeding - insuff. data
What are some adverse effects associated with adalimumab use?
nausea, vomiting, dyspepsia, GI haemorrhage, abdominal pain.
hyperlipadaemia, hypertension, oedema, flushing
Chest pain, tachycardia, worsening heart failure
Cough, dysponea, fever, hypersensitivty reactions.
injection site reactions.
What are the characteristic pharmacokinetic/pharmacodynamic parameters regarding adalimumab?
slow absorption (Subcut dose), peak serum concentration at 5 days.
average absolute bioavailability: 64%
Vd: 4.7-6.0L
Elimination half life: ~2 weeks
Metabolism: liekly to be by opsonization via the reticuloendothelial system
Clearance: 12mL/h (slow and decreases slightly with age)
What are some drug interactions associated with adalimumab use?
increased risk of side effects when given with abatacept
avoid concomitant use with anakinra
avoid concomitant use with live vaccines
What are some monitoring points regarding adalimumab use?
Patients should be evaluated for TB before treatment. Active TB to be treated for at least 2 months before initiating adalimumab. Monitored every 3 months for possible recurrence.
Monitor FBC, infections etc.
What are the alarm bells associated with adalimumab use?
as with all biologicals, injection site reactions possibility of reactivation of TB congestive heart failure serious opportunistic infections avoid live vaccines
