Adalimumab is an anti TNF which has been approved by NICE for AS and non radiographic axial spondyloarthritis.
Adalimumab is only available on prescription from a consultant rheumatologist.
It is taken fortnightly by an injection under the skin using a special 'pen' device. You, your partner, or another member of your family are shown how to do the injection. If this is not possible, the injections can be given by your rheumatology nurse specialist or district nurse.
If you are being prescribed adalimumab it is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on adalimumab and that you are therefore at risk of its side-effects, including infections.
Time adalimumab takes to work
If you respond to adalimumab your symptoms will start to improve in 2-12 weeks.
Possible side effects
Reactions at the injection site such as redness, swelling or pain may occur. These reactions are not usually serious.
Adalimumab lowers the immune system and so you may be more likely to develop infections. Avoid close contact with people with infections and be extra careful with food safety.
Contact your doctor or rheumatology nurse straight away if you develop any of the following symptoms:
- sore throat
- other symptoms of infection such as coughing up green phlegm or diarrhoea
- new symptoms or anything else that concerns you.
You should stop adalimumab and see your doctor immediately if:
- any of the symptoms listed above are persistant or severe
- you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
- you develop chickenpox or shingles.
Chickenpox and shingles can be severe in people who are on treatments that affect the immune system such as adalimumab. You may need antiviral treatment, which your doctor will be able to prescribe and you will need to stop adalimumab until you are better.
In rare cases, people may have an allergic reaction to adalimumab.
Potential risks associated with adalimumab
There may be a slightly increased risk of some cancers with adalimumab as it interferes with the immune system. This is theoretically possible because the immune system is involved in recognising and killing cancerous cells. It's important to bear in mind that this link hasn't been proven and is still being extensively researched. A a review in 2012 of studies involving over 25,000 patients found no increase in the risk of cancer.
Very rarely, people taking adalimumab may develop a condition called drug induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, the adalimumab will be stopped and the condition then usually disappears.
If you're taking adalimumab it's recommended that you avoid live vaccines such as yellow fever. If you do need a live vaccine do discuss all the possible risks and benefits of the vaccination with your doctor.
If you're in your 70s your doctor may advise you to have the shingles vaccination (Zostavax) before starting adalimumab. This vaccination is not recommended for people who are already on adalimumab.
Pneumovax (pneumonia) and yearly flu vaccines are recommended for everyone on adalimumab.
Adalimumab may be prescribed along with other medicines. Do discuss any new medications with your doctor before starting them, and always tell any doctor treating you that you are on adalimumab.
Adalimumab is not a painkiller. If you are already on a non-steroidal anti inflammatory drug (NSAID) or painkillers you can carry on taking these as well as adalimumab, unless your doctor advises otherwise.
Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.
There is no known interaction between adalimumab and alcohol.
Adalimumab and surgery
If you are going to have an operation please inform your doctor, as you are likely to be advised to stop the adalimumab temporarily before and after surgery.
Adalimumab and fertility or pregnancy
The British Society for Rheumatology produced new guidelines on the use of anti TNF therapy such as adalimumab during pregnancy.
Adalimumab and travelling
If you are travelling abroad and taking your anti TNF therapy with you, it's important to make plans to keep it at the correct temperature during the journey and at your destination. You can buy special cool bags and even travel fridges. A useful company to try to purchase these products is MedActiv.
Another option is to use a Frio wallet or carry case. These are designed to keep insulin cool but work well for anti TNF. You can buy these through Amazon.
In addition to your anti TNF medication you may require a travel size sharps box. Do discuss this with your Clinical Nurse Specialist or your delivery team.
There's more travel tips in the `Living with AS` section of the website.
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