What are the correct statements regarding adalimumab (Humira) therapy for a patient with rheumatoid arthritis?

From the Guidelines

Adalimumab (Humira) therapy for rheumatoid arthritis is associated with an increased risk of infections and malignancies, and it is not recommended for individuals with untreated hepatitis C, and may reactivate latent tuberculosis. The correct statements regarding adalimumab (Humira) therapy for a patient with rheumatoid arthritis are:

• May lower the immune response and increase risk of infections and malignancies
• This medication is not recommended for individuals with untreated hepatitis C
• May reactivate latent tuberculosis These statements are supported by the evidence from studies such as 1 and 1, which highlight the potential risks and side effects of adalimumab therapy, including increased risk of infections, malignancies, and reactivation of latent tuberculosis. Additionally, adalimumab is not available as an oral agent, it is administered subcutaneously, and there is no association with osteoporosis that requires baseline and periodic DXA scans. It is essential to carefully evaluate the benefits and risks of adalimumab therapy and to monitor patients closely for potential side effects, as recommended by the EULAR guidelines 1. Key considerations for adalimumab therapy include:
• Screening for tuberculosis and hepatitis B before initiating therapy
• Avoiding live vaccines during treatment
• Monitoring for serious infections, demyelinating disorders, and heart failure
• Evaluating treatment response after 3-6 months and considering alternative therapies if inadequate improvement occurs.

From the FDA Drug Label

Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death [see Warnings and Precautions (5. 1)]. Reported infections include: Active tuberculosis (TB), including reactivation of latent TB. Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers including HUMIRA [see Warnings and Precautions (5. 2)]. The recommended subcutaneous dosage of HUMIRA for adult patients with rheumatoid arthritis (RA) is 40 mg administered every other week

The correct statements regarding adalimumab (Humira) therapy for a patient with rheumatoid arthritis are:

• b. May lower the immune response and increase risk of infections and malignancies: Adalimumab can increase the risk of serious infections and malignancies, including lymphoma.
• c. This medication is not recommended for individuals with untreated hepatitis C: Although not directly stated in the provided text, it is a general precaution for medications that suppress the immune system, such as adalimumab.
• e. May reactivate latent tuberculosis (TB): Adalimumab can reactivate latent TB, and patients should be tested for latent TB before and during therapy. The following options are incorrect:
• a. There is an association with osteoporosis and baseline and periodic DXA scans should be ordered: There is no direct information in the provided text regarding the association between adalimumab and osteoporosis.
• d. This medication is only available as an oral agent: Adalimumab is administered subcutaneously, not orally. 2

From the Research

Correct Statements Regarding Adalimumab Therapy

The following statements are correct regarding adalimumab (Humira) therapy for a patient with rheumatoid arthritis:

• b. May lower the immune response and increase risk of infections and malignancies: This is a known effect of TNF-alpha inhibitors like adalimumab, as they suppress the immune system, potentially increasing the risk of infections and malignancies 3, 4.
• c. This medication is not recommended for individuals with untreated hepatitis C: While the provided studies do not directly address hepatitis C, it is a general precaution for biologic therapies like adalimumab to be used with caution in patients with chronic infections, including hepatitis C.
• e. May reactivate latent tuberculosis: There is evidence suggesting that adalimumab, like other TNF-alpha inhibitors, can reactivate latent tuberculosis due to its immunosuppressive effects 5, 4.

Incorrect Statements

The following statements are incorrect:

• a. There is an association with osteoporosis and baseline and periodic DXA scans should be ordered: The provided studies do not mention an association between adalimumab and osteoporosis.
• d. This medication is only available as an oral agent: Adalimumab is administered subcutaneously, not orally 3, 6, 7.