Adalimumab tuberculosis

Adalimumab (Humira) 40 mg every other week SC injection 1-4 weeks ISR Monitor for infection Screen for tuberculosis... 

Infliximab has been associated with infusion reactions, serum sickness, sepsis, and reactivation of latent tuberculosis. Adalimumab carries risks similar to infliximab. 

IX.b.3.4. Genetically engineered antibodies. Anti-TNF antibody treatment with infliximab or adalimumab is now accepted as of value in treating severe and fistulating exacerbations of Crohn s disease when standard treatments are not tolerated or have failed. Adverse effects which limit usefulness include the occurrence of tuberculosis and septicaemia, leucopenia and pancytopenia, and risk of exacerbation of demyelinating disease. Considerations of benefits versus risks of such treatment are complex, but probably positive. 

Toxicity Temperature, blood pressure periodically, signs and symptoms of respiratory infection, including tuberculosis, hypersensitivity anti-adalimumab antibodies (ELISA) at least once during therapy anti-dsDNA antibody determinations in patients presenting with lupus-like symptoms (e,g, tiredness, rash, bone pain), CBC, routine blood chemistry periodically during long-term therapy... 

Note TNF blocking agents may lead to serious infections, lymphoma, or fatalities, particularly in patients receiving concomitant immunosuppressive therapy. Patients should be evaluated for latent tuberculosis prior to treatment with adalimumab. 

Infection risk The risk of infection, in particular tuberculosis, is increased in patients receiving TNF alfa antagonists. Data from the British Society for Rheumatology Biologies Register, a national prospective observational study, have been used to evaluate the rates of tuberculosis in 3504 patients with rheumatoid arthritis treated with adalimumab [33 ]. The rate of tuberculosis was 144 events per 100 000 person-years, and the median time to event was 18 months. 

Infection risk There have been reports of tuberculosis in patients receiving adalimumab, in most cases extrapulmonary [105 ]. The risk of tuberculosis was higher in patients receiving anti-TNF monoclonal antibodies than those who were receiving soluble TNF receptors. Some patients who have previously received treatment for latent or active tuberculosis have developed active tuberculosis while being treated with adalimumab. 

Infection risk In a case illustrating that tuberculosis can occur in multiple organs during adalimumab therapy, a 39-year-old man with ankylosing spondylitis and treated with the anti-TNFa mAb developed multiple organ tuberculosis including infection of the lung, pleura and peritoneum [85 ]. 

Tuberculosis, especially as a pulmonary infection, is an important side effect in rheumatoid arthritis patients treated with anti-TNFa agents. Pulmonary tuberculosis and tuberculous arthritis of a knee joint were diagnosed with the aid of chest X-ray and tuberculos/polymerase chain reaction (PCR) of joint fluid in a 72-year-old woman being treated with adalimumab/etanercept. The patient had a 10-year history of seropositive rheumatoid arthritis but also type 2 diabetes mellitus, left knee pain, joint effusion and fatigue. The anti-TNFa therapy was believed to be the initiator of the infection [87 ]. 

Yoo W-H. Multiple organ tuberculosis of lung, plevua, and peritoneum in ankylosing spondylitis during adalimumab therapy. Rheumatol Int2012 32(3) 787-90. 

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