One of five currently available anti-TNFα biologics, Adalimumab is a fully human recombinant IgG1κ monoclonal immunoglobulin which binds with high affinity and specificity to both soluble and cell-surface bound forms of TNFα. Adalimumab blocks the interaction of TNFα with the p55 and p75 surface TNF receptors. It does not bind lymphotoxin-a.
TNFα is a central mediator of inflammation that is involved in the induction and maintenance of numerous inflammatory disorders. Adalimumab modulates biological responses that are induced or regulated by TNFα, including changes in the levels of adhesion molecules responsible for leukocyte migration such as ELAM-1, VCAM-1 and ICAM-1. Adalimumab was the first fully human monoclonal antibody approved by the FDA for use in rheumatoid arthritis in 2002. It has subsequently received label indications for psoriatic arthritis (2005), ankylosing spondylitis (2006), Crohn's disease (2007), and plaque psoriasis (2008), children aged 2 and above with juvenile idiopathic arthritis (2008), ulcerative colitis (2012), pediatric Crohn's disease, aged 6 years and older (2014) and moderate to severe hidradenitis suppurativa (2015). Dosing schedules are typically 40 mg subcutaneously every two weeks for arthritic diseases. For Crohn’s Disease and Pediatric doses see: http://www.drugs.com/dosage/adalimumab.html
In long-term studies evaluating adalimumab for two common indications, adalimumab was demonstrated to be safe and effective in a 5-year study in patients with active rheumatoid arthritis and in a four-year study in patients with moderate to severe active ulcerative colitis in maintaining remission or controlling symptoms. An analysis of data extracted from 23,458 patients entered in multi-national clinical trials involving rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn’s Disease, indicated that adalimumab was safe, but the expected increase in infections and lymphomas were reported.
Adverse reactions of adalimumab are similar to other TNF antagonists. The major concerns are infectious diseases such as TB, fungi, Legionella or hepatitis B reactivation; lymphomas; autoimmunity including demyelinating disease and lupus; allergic reactions; cytopenias; and congestive heart failure.
Adalimumab biosimilars, M 923 [Baxalta-Momenta], ABP 501(Amgen), GP2017 (Sandoz), BI695501 [Boehringer-Ingelheim] and SB5 (Samsung) are in clinical trials and may become available in the next several years.
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