What is the recommended dose of Humira (adalimumab) for moderate to severe plaque psoriasis?

Humira (Adalimumab) Dosing for Psoriasis

The recommended dose of Humira (adalimumab) for moderate to severe plaque psoriasis is 80 mg subcutaneously at week 0, followed by 40 mg at week 1, and then 40 mg every other week thereafter as maintenance therapy. 1, 2

Standard Dosing Regimen

• Initial dose: 80 mg subcutaneously (given as two 40 mg injections) at week 0
• Second dose: 40 mg subcutaneously at week 1
• Maintenance dose: 40 mg subcutaneously every other week starting at week 3

This dosing regimen is supported by both the American Academy of Dermatology guidelines and the British Association of Dermatologists' guidelines 1.

Dose Optimization

For patients with suboptimal response to the standard every-other-week dosing, the following adjustments can be considered:

• Increased frequency: A maintenance dose of 40 mg weekly may be recommended for better disease control in some patients 1, 3
• Evaluation timeframe: Assess response at week 16; if inadequate response (defined as <PASI 50), consider dose escalation 1, 4
• Dose escalation strategy: Increase from 40 mg every other week to 40 mg weekly 4

Studies show that approximately 26.6% of patients achieve PASI 75 response 12 weeks after dose escalation, and 38.1% achieve this response by 24 weeks after escalation 4.

Special Populations

• Weight considerations: Patients who weigh ≤102 kg with disease duration <8.3 years are most likely to benefit from dose escalation if needed 4
• Secondary non-responders: Patients who initially respond but later lose response may particularly benefit from dose escalation 4

Combination Therapy Options

To enhance efficacy, adalimumab may be combined with:

• Topical therapies: High-potency corticosteroids with/without vitamin D analogues 1, 5
• Systemic agents:
  • Methotrexate (reduces immunogenicity and increases effectiveness) 1, 5
  • Acitretin (particularly beneficial in palmoplantar psoriasis) 1, 5
  • Narrowband ultraviolet phototherapy 1, 5

Monitoring and Safety Considerations

• Pre-treatment: Tuberculosis screening, complete blood count, liver function tests, and hepatitis profile 1, 5
• During treatment: Periodic history and physical examination, consider yearly TB testing, and periodic CBC and LFT 1, 5
• Continuous therapy: Maintain continuous therapy as interrupted treatment may result in loss of efficacy 1, 5

Efficacy Expectations

• Short-term results: Approximately 80% of patients achieve PASI 75 at 12 weeks 1
• Long-term results: About 68% of patients maintain PASI 75 at 60 weeks 1

Common Pitfalls to Avoid

1. Interrupting therapy: Avoid interruptions as this may lead to loss of efficacy and reduced response upon restarting 1, 5
2. Inadequate monitoring: Failure to screen for TB or monitor for adverse events can lead to serious complications 1, 5
3. Delayed dose optimization: Not escalating dose in patients with suboptimal response after 16 weeks may result in continued poor disease control 4, 3
4. Overlooking combination therapy: Not considering combination therapy options for patients with inadequate response to monotherapy 1, 5

The FDA-approved label for Humira confirms this dosing regimen, specifying that for plaque psoriasis, the recommended subcutaneous dosage is an initial dose of 80 mg, followed by 40 mg given every other week starting one week after the initial dose 2.