What monitoring and management strategies are recommended for a patient on long-term Humira (adalimumab) therapy with health anxiety, especially concerning cancer risk?

From the Guidelines

Patients on long-term Humira (adalimumab) therapy with health anxiety, especially concerning cancer risk, should be managed with a comprehensive approach that includes regular screening for anxiety using a valid and reliable tool like the GAD-7 scale, as recommended by the American Society of Clinical Oncology 1. This approach is crucial because health anxiety, particularly regarding cancer, can significantly impact a patient's quality of life. The management strategy should prioritize transparent communication about the risks and benefits of Humira therapy, including its modest increased risk for certain cancers, such as non-melanoma skin cancers and lymphomas 1. Key components of the monitoring strategy include:

• Regular clinical assessments every 3-6 months
• Laboratory monitoring of complete blood count, liver function tests, and renal function
• Cancer surveillance following age-appropriate guidelines, including annual skin examinations, colonoscopy starting at age 45 (or earlier with risk factors), mammograms for women over 40, and Pap smears as recommended
• Education on Humira's risks and benefits, emphasizing the low absolute risk of cancer and the importance of controlling the underlying condition
• Encouragement of protective measures like sun protection, smoking cessation, and prompt reporting of concerning symptoms For patients with identified anxiety, particularly those with moderate to severe symptoms, consideration of pharmacologic and/or nonpharmacologic interventions delivered by appropriately trained individuals is essential, with a preference for non-pharmacologic approaches when possible, as suggested by guidelines on managing anxiety in cancer patients 1. It's also important to use a stepped care model to tailor intervention recommendations based on variables such as symptomatology level, functional impairment, presence of risk factors, and patient preference, as outlined in guidelines for screening, assessment, and care of anxiety and depressive symptoms in adults with cancer 1.

From the FDA Drug Label

Consider the risks and benefits of TNF-blocker treatment including HUMIRA prior to initiating therapy in patients with a known malignancy other than a successfully treated non-melanoma skin cancer (NMSC) or when considering continuing a TNF blocker in patients who develop a malignancy Malignancies in Adults In the controlled portions of clinical trials of some TNF-blockers, including HUMIRA, more cases of malignancies have been observed among TNF-blocker-treated adult patients compared to control-treated adult patients

• Monitoring and management strategies for a patient on long-term Humira (adalimumab) therapy with health anxiety, especially concerning cancer risk, include:

• Closely monitoring patients for the development of signs and symptoms of infection during and after treatment with HUMIRA
• Evaluating patients for tuberculosis risk factors and testing for latent infection prior to initiating HUMIRA and periodically during therapy
• Considering the risks and benefits of treatment prior to initiating therapy in patients with a known malignancy other than a successfully treated non-melanoma skin cancer (NMSC) or when considering continuing a TNF blocker in patients who develop a malignancy 2

• Key considerations:

• The incidence of malignancies was greater in HUMIRA-treated patients than in controls
• Patients with a history of malignancy should be closely monitored for recurrence during treatment with HUMIRA 2

From the Research

Monitoring Strategies for Humira Therapy

• Regular monitoring of patients on long-term Humira (adalimumab) therapy is crucial to minimize the risk of adverse effects, including serious infections and potential cancer risk 3.
• Laboratory monitoring, such as blood counts and liver function tests, may be useful, especially in patients with a history of certain health issues 3.
• Tuberculosis screening should be performed according to country standards, and patients should be monitored for signs of tuberculosis reactivation 3.

Management of Health Anxiety

• Patients with health anxiety, particularly regarding cancer risk, should be closely monitored and supported by their healthcare team 4.
• Open communication and education about the potential risks and benefits of Humira therapy can help alleviate anxiety and improve treatment adherence.
• Patient support programs, such as the HUMIRA Complete program, have been shown to improve medication adherence and lower total healthcare costs despite increased drug spending 5.

Cancer Risk and Humira Therapy

• There is a potential increased risk of certain types of cancer, such as lymphoma, associated with Humira therapy 3.
• However, the overall risk of cancer is still relatively low, and the benefits of Humira therapy often outweigh the risks for patients with certain chronic conditions.
• Regular monitoring and follow-up appointments with a healthcare provider can help identify any potential cancer risks early on.

Adalimumab-Induced Central Nervous System Demyelination

• Central nervous system demyelination is a rare side effect of adalimumab, and patients should be monitored for signs of demyelinating diseases 4.
• Brain MRI scans may be performed to monitor for demyelination, especially in patients with a history of neurological conditions.