An anti-TNF biologic
Adalimumab
An injectable anti-TNF biologic used for rheumatoid arthritis, psoriasis, inflammatory bowel disease and related conditions.
What is Adalimumab?
Adalimumab is a biologic medicine that blocks a chemical messenger called TNF, which drives inflammation in conditions such as rheumatoid arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease. It is given by injection under the skin, usually every two weeks, and is not a tablet. Because it dampens the immune system, the main risk is serious infection, so you are screened for tuberculosis and hepatitis B and C before starting. Live vaccines must be avoided while you are on it, but routine jabs such as the flu vaccine are encouraged. Several brands, such as Amgevita, Imraldi, Hyrimoz and Idacio, are biosimilars of the original Humira and are prescribed by brand name.
Education and reference only. This is a plain-language guide to Adalimumab — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Adalimumab is a biologic medicine, a protein made using living cells rather than a chemical tablet. It belongs to the anti-TNF group, which calm down an overactive immune system in long-term inflammatory diseases. It is used for rheumatoid arthritis and other forms of inflammatory arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease such as Crohn's disease and ulcerative colitis, among others. It is given as an injection under the skin, often using a pre-filled pen or syringe that you or a carer can be taught to use at home. Several of its brands are biosimilars, highly similar versions of the original medicine.
How it works
Adalimumab attaches to and blocks a natural messenger called tumour necrosis factor (TNF), which is one of the main drivers of inflammation in these conditions. By mopping up TNF, it reduces the swelling, pain, stiffness and tissue damage that the overactive immune response causes. Because TNF is also part of the body's defence against infection, dampening it lowers the immune system's guard, which is why infections such as tuberculosis can flare up. The effect builds up over weeks, and people are usually reviewed to see whether their disease is responding.
Company & origin
Originated / developed by: AbbVie (originator) and biosimilar makers.
A widely used anti-TNF biologic injection used in the UK for several long-term inflammatory conditions.
What it treats
Conditions Adalimumab is used for
Practical use
How to take Adalimumab
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by injection under the skin, usually every two weeks, not as a tablet.
- You or a carer can often be taught to inject at home using a pre-filled pen or syringe, rotating the injection site each time.
- Take it exactly as prescribed and keep using it even when you feel well, as it controls a long-term condition.
- Store the pens or syringes in the fridge as instructed, and let an injection reach room temperature before using it to reduce stinging.
- Do not have any live vaccines while on treatment, and tell any healthcare professional that you take a biologic.
- Contact your team promptly if you develop a fever, persistent cough, night sweats or other signs of infection.
Weighing it up
Advantages & disadvantages of Adalimumab
Advantages
- Can bring marked relief from pain, swelling and stiffness across several inflammatory conditions when other treatments have not worked.
- Given conveniently by injection under the skin, often self-administered at home every two weeks.
- Lower-cost biosimilar brands have widened access while working in the same way as the original.
Disadvantages
- Lowers the body's defences, so serious infections are more likely and need prompt attention.
- Requires screening for tuberculosis and hepatitis before starting and ongoing monitoring during treatment.
- Cannot be given with live vaccines, and some people develop injection-site reactions.
Practical use
Good to know
Adalimumab works by quietening the immune system, so serious infection is the most important risk to understand. Before you start, you will be screened for tuberculosis and for hepatitis B and C, because these can wake up and spread during treatment. While you are on it, live vaccines must be avoided, but other vaccines such as the annual flu jab and pneumonia vaccine are encouraged and are best arranged before starting where possible. Report any signs of infection, such as fever, a persistent cough or night sweats, promptly. Anti-TNF medicines are used with caution in people with heart failure or a history of nerve conditions affecting the brain or spinal cord, and there is a small, much-discussed possible signal of certain cancers such as lymphoma, which your specialist will weigh against the benefits. Many brands are biosimilars, and your team may prescribe a specific brand and ask you to stay on it.
Who should not take it / use with caution
- People with an active serious infection, including active or untreated tuberculosis, should not start it until this is dealt with.
- It is generally avoided in moderate to severe heart failure and used very cautiously where there is a history of demyelinating nerve disease such as multiple sclerosis.
- It should not be used by people who have had a severe allergic reaction to adalimumab or its ingredients.
Monitoring
- Screening for tuberculosis and hepatitis B and C before starting, and watching for infection throughout treatment.
- Regular review of how well the condition is responding and whether to continue.
- Blood tests as advised, particularly if it is combined with other medicines such as methotrexate.
Side effects
- Injection-site redness, swelling or soreness, and an increased risk of infections such as colds, chest and urinary infections.
- Headache, rash, nausea and feeling generally run down can occur.
- Less commonly, reactivation of tuberculosis or hepatitis B, and rare serious infections or allergic reactions that need urgent care.
Key interactions
- Should not be combined with live vaccines, which must be avoided during treatment.
- Combining it with other strong immune-suppressing biologics increases the risk of serious infection and is generally avoided.
- It is often used alongside methotrexate in arthritis, which your team will monitor together.
Available as: Pre-filled pen or syringe for injection under the skin.
Answers
Adalimumab: frequently asked questions
Is adalimumab a tablet?
No. It is a biologic given by injection under the skin, usually every two weeks, often self-administered at home with a pre-filled pen or syringe.
Why do I need a TB test before starting?
Adalimumab dampens the immune system, so a hidden tuberculosis infection could reactivate; screening for TB and hepatitis B and C before starting helps prevent this.
Can I have my vaccinations?
Live vaccines must be avoided while on adalimumab, but non-live vaccines such as the flu and pneumonia jabs are encouraged, ideally arranged before you start.
Is Amgevita the same as Humira?
Amgevita, like Imraldi, Hyrimoz and Idacio, is a biosimilar of the original Humira, meaning it is a highly similar version that works in the same way; your team prescribes by brand name.
What should I do if I feel I am getting an infection?
Contact your healthcare team promptly if you develop a fever, persistent cough, night sweats or other signs of infection, as these need to be checked.
The wider class
About Anti-TNF biologic
Adalimumab belongs to the anti-tnf biologic class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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