Humira, with the generic name adalimumab, is a drug that is used to relieve pain and reduce inflammation in people with a number of autoimmune diseases.
Autoimmune diseases are not curable, but some of the symptoms, such as pain and inflammation can be controlled with medications.
Humira belongs to a class of drugs called biologics. Biologics are normally derived from a living organism, such as humans, animals, microorganisms or yeast.
The therapy is based on proteins, usually antibodies. The proteins are developed using DNA technology, otherwise known as genetic engineering.
Patients normally take Humira at home, using a preloaded syringe or a pen device. The human digestive system would destroy the active ingredient, so it cannot be taken orally.
Contents of this article:
How Humira affects autoimmune diseases
Humira can bring relief from symptoms of autoimmune diseases such as rheumatoid arthritis.
An autoimmune disease is one in which the body's immune system falsely detects and attacks a threat within the body that does not really exist.
This can lead to a number of problems and conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, and psoriasis.
Experts are unsure exactly what causes autoimmune diseases, but tumor necrosis factor alpha (TNFα) appears to be a major contributor to inflammation in these diseases.
TNFα triggers inflammation when the body is under threat, and the immune system goes into action to protect it. However, too much TNFα can attack healthy tissue and cause inflammation.
Humira binds to TNFα and blocks its inflammatory effect. This reduces pain and inflammation in patients with autoimmune diseases.
The word HUMIRA stands for HUman Monoclonal Antibody In Rheumatoid Arthritis.
Conditions that benefit from Humira
Clinical trials have shown that Humira is effective for patients with a range of auto-immune diseases, and it has been approved for these conditions.
Active ankylosing spondylitis
This is a chronic inflammation of the spine and sacroiliac joints. The patient feels pain and stiffness in and around the area of the spine. Eventually, the chronic inflammation can lead to complete fusion of the vertebrae. This process is called ankylosis.
Ankylosing spondylitis sometimes occurs in people with inflammatory bowel disease, such as ulcerative and Crohn's colitis, and psoriasis.
An evidence-based review published in 2007 suggests that Humira is effective in treating ankylosing spondylitis and describes its use as "cost-effective."
Moderate to severe chronic plaque psoriasis
Around 80 percent of patients with psoriasis have this type of psoriasis.
Humira can help with psoriasis and psoriatic arthritis.
The patient has well-defined patches of red raised skin, usually on the trunk, scalp, elbows, knees and nails, but the patches can appear anywhere on the skin. Scale builds up on top of the plaques.
People with psoriasis have very dry skin that can itch, crack, and be painful.
In July 2016, Decision Resources Group (DRG) noted that Humira and similar biologics are continuing to gain popularity as a treatment for psoriasis.
Moderate to severe psoriatic arthritis
This condition leads to joint inflammation. It affects about 1 in every 10 people with psoriasis.
Humira is commonly used to treat psoriatic arthritis, but researchers are still investigating the best ways to use it.
A 2015 study suggests that health care providers should tailor the therapy to individual needs, as studies show that when blood concentration of Humira is between 5 and 8 milligrams, the drug is effective, but outside this range, it is not beneficial.
Moderate to severe Crohn's disease
This is a chronic condition that causes inflammation of the digestive tract. Any part of the gut can be affected, from the mouth to the anus. In most cases the ileum, or lower part of the small intestine, is affected. Symptoms include pain, and their intestines empty frequently, resulting in diarrhea.
Authors of a review published in 2013 state that "The advent of anti-tumor necrosis factor (TNF) therapies revolutionized the treatment of inflammatory bowel disease."
They conclude that among people with Crohn's disease, Humira is most likely to be useful for patients with a moderate condition. They call for further research into the safety and effectiveness of using it for longer than a year.
Moderate to severe juvenile idiopathic arthritis
This is an inflammation of one or more joints, and it starts in childhood. Pain is an important symptom, and it often improves during the day.
Moderate to severely active rheumatoid arthritis
Rheumatoid arthritis (RA), or rheumatoid disease, is a chronic, progressive, and disabling autoimmune disease that causes pain and inflammation in the joints, the tissues around the joints, and other organs.
A study published in 2011 observes that biologics have "transformed" the treatment of RA. They comment that while expensive, biologics may be more cost-effective in the long term.
The authors note:
"Although biologic agents are more costly in the short term than conventional disease-modifying antirheumatic drugs, drug-specific costs may be offset by significant improvements in RA symptoms, slowed disease progression, and improved physical function and quality of life for patients."
Moderate to severe hidradenitis suppurativa
Hidradenitis suppurativa (HS) is a chronic condition that leads to abscesses and scarring on the skin. It occurs near hair follicles around the sweat glands, and it is thought to affect about 1 percent of people.
It is difficult to manage, although antibiotics may help. In severe cases, immunosuppressant drugs such as Humira can help.
How to use Humira
Humira is a long-term treatment. Patients respond at different speeds to its analgesic and anti-inflammatory effects. According to the manufacturers, Abbvie, some people see benefits after 2 weeks, while others may need to take it for 3 months or longer to seen an improvement.
It is vital for the patient to adhere to the treatment plan for best results. Those who stop taking their medications are most likely to have overactive immune systems again.
How to use the Humira pen or syringe
Humira is injected into either the abdomen or the thighs, using a prefilled pen or syringe. The injection should not be given in skin that is bruised or tender, or where there are patches of psoriasis.
Patients normally administer Humira themselves. A single-use pen contains 40 milligrams of medication, while a syringe may contain 40, 20, or 10 milligrams.
Humira use begins with a starting dose, followed by regular doses, normally every second week. A doctor will advise the patient about their dosage requirements.
There are specific instructions for storage and use, and patients are advised not to use the Humira pen or syringe without first being shown by a doctor and without reading the full instructions.
Patients are advised to practice first with a health care professional, to ensure they are not startled by the click when administering the dose.
Adverse effects and cautions
Humira can have a number of adverse effects.
As Humira is an immunosuppressant, it will leave the body more prone to infections. The use of TNF blockers has also been linked to cancer, including some rare and unusual types of cancer.
Common adverse effects include, but are not limited to:
- Redness, rash, swelling, itching or bruising at the injection site
- Infections, especially upper respiratory infections and sinus infections
- Headaches and nausea
Some serious side effects require immediate medical attention.
Serious infections can occur due to the immunosuppressant qualities of Humira. These include tuberculosis (TB) and other infections caused by viruses, fungi, or bacteria.
Infections may develop in carriers of hepatitis B. Symptoms include fever and chills, muscle pain, fatigue, dark urine and a yellow tinge to the eyes of skin, loss of appetite, vomiting, clay-colored feces, stomach problems, and skin rash.
Hives can be a sign of an allergic reaction.
Some people may have an allergic reaction. Symptoms include chest tightness, wheezing, and other breathing difficulties, hives, itching, and skin rash, swelling of the tongue, lips, face and other parts of the body.
Nervous system problems may occur, leading to weakness in the arms and legs, numbness, tingling, visual disturbances and dizziness.
Blood problems may occur. A low platelet count can lead to an increased likelihood of bleeding, and a low level of white blood cells make it harder to fight infection. The patient may have a fever that does not go away, or finds they are bruising or bleeding easily.
Heart conditions can develop or get worse, leading to shortness of breath, sudden weight gain, and swelling in the hands and feet.
Immune reactions may occur. One example is a lupus-like syndrome, with chest pain and shortness of breath, joint pain, or a rash on the cheeks or arms that worsens when exposed to the sun.
Liver problems can arise, leading to fatigue, yellowish skin or eyes, vomiting and not wanting to eat, and abdominal pain.
Psoriasis may emerge or worsen.
Patients should not take Humira if they are allergic to any medication containing adalimumab or Mannitol, sodium citrate, monobasic sodium phosphate dehydrate, sodium chloride, citric acid monohydrate, or polysorbate 80.
It is important to disclose any current medications and medical conditions before using Humira.
Humira should not be used by anyone with a severe infection, active TB, and other infections that may occur when the immune system is weakened.
It should not be taken with a number of drugs, including Kineret (anakinra) and Orencia (abatacept).
Before using Humira, the patient should ensure their doctor knows if they have or have ever had any of the medical conditions listed below:
- Any type of infection, including a localized one, such as a leg ulcer
- A fungal infection
- Allergy to latex or rubber
- Any heart condition
- Any type of autoimmune disease
- Any type of demyelinating disease, including multiple sclerosis
- Liver or kidney problems
- Recurrent infections, or any conditions which increase infection risk
The doctor also needs to know if the patient is taking any immunosuppressant medications, if they or anyone close to them has, or has had, tuberculosis (TB), and if the person is a carrier of the hepatitis B virus.
Some people may be able to get help with Humira from their insurance company. This link can provide more information.
Other products that work in a similar way, known as biosimilars, are also available. In September 2016, Amjevita gained the approval of the United States Food and Drug Administration (FDA).
Amjevita can also be used in cases of moderately to severely active polyarticular juvenile idiopathic arthritis from the age of 4 years.