Arthritis Treatment Biologics What to Know About Humira (Adalimumab) An injectable biologic drug for rheumatoid arthritis By Carol Eustice Carol Eustice Facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Updated on December 15, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Scott Zashin, MD Medically reviewed by Scott Zashin, MD LinkedIn Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Uses Before Taking Dosage How to Take and Store Side Effects Warnings/Interactions Humira (adalimumab) is a biologic drug used in the treatment of rheumatoid arthritis (RA) and some other autoimmune and inflammatory diseases to manage symptoms and disease progression. It's a TNF inhibitor (or TNF blocker) that works by blocking the activity of the tumor necrosis factor-alpha (TNFα) protein. Humira comes in liquid form and you inject yourself with it at home. Approved in 2002, Humira was the third TNF inhibitor. Generic forms of Humira are not available. However, several biosimilars are on the market. Maskot/Getty Images Uses Normally, TNFα helps your immune system fight infection, but in excess amounts, it can cause painful inflammation and severe joint damage—which are common effects of RA, other forms of inflammatory arthritis, and autoimmune diseases. Drugs like Humira have helped a lot of people with these diseases by: Relieving painImproving joint functionSlowing disease progression Humira is a fully-humanized monoclonal antibody. As with all biologics, it's made from biological material. "Fully humanized" means that it's made from cloned human antibodies (earlier TNF inhibitors use combinations of rodent and human DNA). Humira is approved by the U.S. Food and Drug Administration (FDA) to treat multiple conditions in adults and children/adolescents. Rheumatoid arthritis: Adults with moderately-to-severely active RA Ankylosing spondylitis (AS): Adults with active AS Psoriatic arthritis (PsA): Adults with active PsA Juvenile idiopathic arthritis (JIA): Children age 2 or older with moderately-to-severely active polyarticular JIA Plaque psoriasis (Ps): Adults with moderate-to-severe Ps who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate Ulcerative colitis (UC): Adults with moderate-to-severe UC who've had an inadequate response to immunosuppressants Crohn's disease (CD): Adults with moderate-to-severe CD who've had an inadequate response to conventional therapy or have become unresponsive to infliximab Pediatric Crohn's disease: Children age 6 and older with moderate-to-severe CD who've had an inadequate response to corticosteroids or immunomodulators Hidradenitis suppurativa (HS): Moderate-to-severe HS in people age 12 and older Uveitis (UV): Non-infectious intermediate, posterior, and panuveitis in adults and children age 2 and older Off-Label Humira is sometimes used off-label, especially for the adolescent forms of adult diseases for which the drug is approved. Safety data are available for children as young as 2. Other frequent off-label uses include: Behçet's disease, especially for ocular (eye) manifestations Scleritis Sarcoidosis Non-infectious ocular inflammation Pyoderma gangrenosum Other autoimmune diseases, including lupus and Sjögren's syndrome Other inflammatory diseases Humira may also be used off-label as part of an early, aggressive treatment strategy for people who have undifferentiated arthritis, a diagnosis that often comes before full-blown RA is apparent. Before Taking TNF inhibitors typically are considered second-line treatments. Healthcare providers generally won't prescribe one until you've tried at least one disease-modifying antirheumatic drug (DMARD), such as methotrexate or sulfasalazine. If you can't tolerate a DMARD or it's not effective enough to keep your symptoms under control, you may be given Humira in addition to your current medication or as a replacement for it. Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks when taken with Humira, others may outright contraindicate use or prompt careful consideration. Precautions and Contraindications Humira may not be safe for some people. Before you start taking this drug, let your healthcare provider know if you have: A known allergy to adalimumab or any of the drug's ingredients An active infection Uncontrolled diabetes or another condition that may make you prone to infection Active hepatitis B or you are a carrier Numbness, tingling Multiple sclerosis A central nervous system disorder Previous heart failure Animal studies do not link this drug to fetal harm or birth defects. Statistics of human pregnancies and births show a slight increase in the association with birth defects and pre-term delivery; however, this may be due to disease activity rather than the drug. Still, Humira is not recommended during pregnancy or breastfeeding. It does cross through the placenta and could impact your baby's immune response during the third trimester. You may need to delay starting Humira if you plan to have surgery or get vaccinations in the near future. Other TNF Inhibitors When choosing a biologic TNF inhibitor for you, your healthcare provider may consider Humira or any of the similar drugs on the market, including: Cimzia (certolizumab pegol) Enbrel (etanercept) Remicade (infliximab) Simponi (golimumab) Biosimilars Biosimilars are what they sound like—drugs designed to work like the biologics they are based on. A biosimilar shouldn't have any meaningful differences from its reference drug, including (and especially) its level of effectiveness. Biosimilars for Humira include: Abrilada (adalimumab-afzb) Amjevita (adalmimumab-atto) Cyltezo (adalimumab-adbm) Hadlima (adalimumab-bwwd) Hulio (adalimumab-fkjp) Hyrimoz (adalimumab-adaz) These drugs are less expensive than biologics. But your pharmacist can't substitute a biosimilar for a biologic—even if your healthcare provider gives them the OK. An entirely new prescription must be written for such a drug. Biosimilars also exist for Enbrel and Remicade. As of mid-2020, none were available for Simponi and Cimzia. Dosage Humira is taken by subcutaneous (under the skin) self-injection once every 14 days. If that's not effective enough for reducing your symptoms, your healthcare provider may increase this to once every week. The drug is available in a single-use, pre-filled syringe or a single-use, disposable injector pen. Available dosages include 10 milligrams (mg), 20 mg, 40 mg, and 80 mg. For some conditions, Humira has a short-term introductory dosage that's different from the long-term maintenance dosage. Always be sure to carefully follow the instructions from your healthcare provider. Standard Humira Dosages for Adults INDICATION INTRODUCTORY MAINTENANCE Rheumatoid arthritis None 40 mg/14 days Psoriatic arthritis None 40 mg/14 days Ankylosing Spondylitis None 40 mg/14 days Crohn's disease 160 mg; 80 mg two weeks later 40 mg/14 days Ulcerative colitis 160 mg; 80 mg two weeks later 40 mg/14 days Plaque psoriasis 80 mg; 40 mg a week later 40 mg/14 days Hidradenitis suppurativa 160 mg; 80 mg two weeks later; 40 mg two weeks after that 40 mg/7 days Uveitis 80 mg; 40 mg a week later 40 mg/14 days Modifications for Children Humira dosages for children and adolescents are based on weight. In some cases, the dosage remains the same as for adults. In others, it must be lowered. Be sure to notify your healthcare provider if your child gains weight or has a growth spurt between refills to ensure the dose is adjusted to your child's new weight. These listed dosages are recommended by the manufacturer. Standard Humira Dosages for Children INDICATION Body Weight INTRODUCTORY MAINTENANCE Juvenile idiopathic arthritis, pediatric uveitis Varies None 22-32 lbs10 mg/14 days33-65 lbs20 mg/14 days66 lbs and up40 mg/14 days Pediatric Crohn's disease 37-87 lbs* Day 1: 80 mgDay 15: 40 mg Day 29: 20 mgRepeat every 14 days thereafter Adolescent hidradenitis suppurativa 66-131 lbs* (over age 12) Day 1: 80 mgDay 8: 40 mg Day 22: 40 mgRepeat every 14 days thereafter *Children exceeding weight ranges can take the adult dose. How to Take and Store Injection is fairly simple since the syringe and pen both come pre-filled with the correct dose of Humira. Your healthcare provider's office should offer you some training on how to inject yourself. The medication should also come with an information packet that instructs you on proper use. AbbVie, the manufacturer, also offers training videos on its website. Humira needs to be kept cold. It will be delivered to you in an insulated container, and you should put it in the refrigerator immediately (unless you're planning to use it right away). Do not freeze this medication, and don't use it if it's ever been frozen. The drug needs to be protected from light. Keep it in the original packaging until you're ready to use it. On injection days, take the medication out of the refrigerator and let it naturally warm up to room temperature. Don't try to warm it up faster. If you'll be traveling or are otherwise unable to keep your Humira cold, it can be stored at room temperature (up to a maximum of 77 degrees F) for up to two weeks. If it stays unrefrigerated for longer than 14 days or exceeds this temperature, do not use it. Make Humira Injections Less Painful Recently, Abbvie has introduced a citrate-free formulation, which has the advantage of being less painful. The needle is thinner and a smaller amount of medication is injected, which can reduce discomfort with the injection. Side Effects With Humira's pluses, like any drug, come potential negatives. It's important to be aware of what's considered normal and what should prompt you to call your healthcare provider. Common The most common side effects with Humira are mild and include: Mild injection site reactionsRashHeadacheNauseaBack pain This should diminish over time. If they do not or become severe, contact your healthcare provider. Severe Less often, more severe side effects can occur. You should call your healthcare provider or get medical help right away if you experience: Numbness or tinglingVision problemsLeg weaknessChest painShortness of breathRash that's sensitive to sunlightNew joint painSigns of infection (e.g., fever, chills, sore throat)Unusual bruising or bleedingPale skinDizzinessRed, scaly patches or pus-filled bumps on your skin An allergic reaction to a medication can be life-threatening and warrant immediate emergency care. Signs of an allergic reaction can include: HivesItchingTightening in the throat (difficulty breathing, swallowing)Swelling (edema) in your face, legs, or feet Warnings and Interactions Humira suppresses your immune system. As with all TNF inhibitors, it comes with two black-box warnings (the FDA's most serious warning type): Serious infections: Humira increases your risk of tuberculosis, sepsis, fungal and other infections. Certain types of cancer: In clinical trials, some patients had higher rates of cancer and lymphoma over a period of 24 months. Some adolescents and young adults have developed a rare type of lymphoma called hepatosplenic T-cell lymphoma while taking TNF inhibitors. Humira may also worsen the symptoms of nervous system diseases, including demyelinating disorders. A condition called lupus-like syndrome is also associated with using this drug. Drug Interactions Some drugs can cause problems when used together. Because of an increased risk of severe infections, Humira shouldn't be combined with: Orencia (abatacept) Kineret (anakinra) Other TNF inhibitors You should also avoid live vaccines while on Humira. Keep in mind that most vaccines are not live vaccines, so you can have most of the recommended immunizations. Speak to your healthcare provider about which vaccines are/are not safe for you while on this drug. While taking Humira, you can also take methotrexate or other non-biologic DMARDs, glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), or analgesics (pain killers), as directed. However, Humira should not be combined with other biologics. Which TNF Inhibitor Is Right for You? Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 12 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Tumor necrosis factor antagonists. 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