Can you take Humira (adalimumab) when diagnosed with pneumonia?

From the Guidelines

It is strongly recommended to temporarily stop taking Humira (adalimumab) if you are diagnosed with pneumonia. This recommendation is based on the understanding that Humira, as a TNF inhibitor, suppresses part of the immune system, which could potentially interfere with the body's ability to fight the pneumonia infection 1. The concern with continuing Humira during an active infection like pneumonia is that it may impair the immune response, potentially allowing the infection to worsen.

When considering the management of patients on biologic therapies like adalimumab who develop infections, guidelines suggest pausing immunosuppressive therapy for the duration of the infection 1. This approach is crucial for ensuring that the patient's immune system can effectively combat the infection without the potential hindrance of immunosuppressive drugs.

Key points to consider include:

• The importance of following guidelines suggested by the rheumatology community for managing infections in patients on immunosuppressive therapies.
• The potential beneficial effects of certain medications, like hydroxychloroquine, in the context of specific infections, which may not require pausing.
• The need for careful consideration and consultation with a healthcare provider before making any changes to medication regimens, especially in the context of active infections.

In the case of pneumonia, temporarily stopping Humira until the infection resolves is a prudent approach, balancing the need to manage the rheumatic condition with the necessity of allowing the immune system to effectively fight off the infection. This decision should always be made in consultation with a healthcare provider, who can assess the individual circumstances and provide personalized advice on when it is safe to resume Humira treatment after the pneumonia has been adequately treated.

From the FDA Drug Label

Infections In the controlled portions of the 39 global adalimumab clinical trials in adult patients with RA, PsA, AS, CD, UC, Ps, HS and UV, the rate of serious infections was 4.3 per 100 patient years in 7973 adalimumab treated patients versus a rate of 2. 9 per 100 patient years in 4848 control-treated patients. Serious infections observed included pneumonia, septic arthritis, prosthetic and post-surgical infections, erysipelas, cellulitis, diverticulitis, and pyelonephritis [see Warnings and Precautions (5. 1)].

Adalimumab and Pneumonia: The use of adalimumab may increase the risk of serious infections, including pneumonia.

• Key Points:
  • Adalimumab can increase the risk of serious infections.
  • Pneumonia is a serious infection that has been observed in patients taking adalimumab.
  • The rate of serious infections, including pneumonia, was higher in adalimumab-treated patients compared to control-treated patients. Given the increased risk of serious infections, including pneumonia, with adalimumab, it is recommended to exercise caution when considering the use of adalimumab in patients with pneumonia. It is not recommended to initiate adalimumab in patients with active pneumonia. Patients with a history of recurrent infections, including pneumonia, should be closely monitored while taking adalimumab. 2

From the Research

Adalimumab and Pneumonia

• Adalimumab, also known as Humira, is a medication used to treat various conditions, including rheumatoid arthritis and Crohn's disease 3.
• There have been reports of patients developing pneumonia while taking adalimumab, particularly in those with pre-existing conditions such as rheumatoid arthritis or Crohn's disease 4, 5, 6.
• A case study published in 2010 reported a 68-year-old woman with Crohn's disease, myasthenia gravis, recurrent uveitis, and rheumatoid arthritis who developed pneumonia while taking adalimumab and conventional immunosuppressive drugs 4.
• Another case study published in 2011 reported a 45-year-old man with Crohn's disease who developed pneumonitis after starting adalimumab 5.
• A study published in 2019 found that adalimumab improved health and disability outcomes in patients with Crohn's disease, rheumatoid arthritis, or psoriasis, but did not specifically address the risk of pneumonia 7.
• However, a case report published in 2010 described a patient with rheumatoid arthritis who developed acute pneumonitis after taking adalimumab 6.

Considerations for Taking Adalimumab with Pneumonia

• Patients with pneumonia should exercise caution when taking adalimumab, as it may increase the risk of worsening the infection 4, 5, 6.
• Healthcare providers should carefully weigh the benefits and risks of adalimumab treatment in patients with pneumonia, particularly in those with pre-existing conditions that may increase the risk of infection 4, 3.
• Patients taking adalimumab should be monitored closely for signs of infection, including pneumonia, and should seek medical attention immediately if they experience any symptoms of infection 4, 5, 6.