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

Adalimumab Dosing for Moderate to Severe Plaque Psoriasis

The recommended dosing regimen for adalimumab (Humira) in moderate to severe plaque psoriasis is an initial dose of 80 mg subcutaneously at week 0, followed by 40 mg at week 1, and then 40 mg every other week starting at week 3. 1, 2

Standard Dosing Protocol

• Initial loading dose: 80 mg subcutaneously (given as two 40 mg injections) at week 0
• Second dose: 40 mg subcutaneously at week 1
• Maintenance dosing: 40 mg subcutaneously every other week starting at week 3 1, 2

Evaluation of Treatment Response

• Assessment of response should be performed at week 16 1
• If inadequate response (defined as <PASI 50) at week 16, consider dose escalation 1
• According to the British Association of Dermatologists guidelines, treatment continuation decision should be made at 16 weeks 3

Dose Adjustment Options

For patients with suboptimal response to standard every-other-week dosing:

• Consider increasing to 40 mg weekly 1, 4
• Clinical data shows that approximately 26.6% of patients achieve PASI 75 response within 12 weeks of dose escalation, and 38.1% achieve this response by 24 weeks after escalation 4

Patient Selection Considerations

Patients most likely to benefit from adalimumab therapy for psoriasis:

• Those with moderate to severe plaque psoriasis (PASI ≥10 and DLQI >10) 3, 1
• Those who have failed to respond to, have contraindications to, or are intolerant of other systemic therapies including ciclosporin, methotrexate, and PUVA 3

Combination Therapy Options

To enhance efficacy, adalimumab may be combined with:

• Topical therapies (high-potency corticosteroids with/without vitamin D analogues) 1
• Systemic agents (methotrexate, acitretin) 1
• Narrowband ultraviolet phototherapy 1

Pre-treatment and Monitoring Requirements

Before initiating therapy:

• Tuberculosis screening
• Complete blood count
• Liver function tests
• Hepatitis profile 1, 2

During treatment:

• Periodic history and physical examination
• Consider yearly TB testing
• Periodic CBC and liver function tests 1, 2

Important Clinical Considerations

1. Avoid interruptions in adalimumab therapy as this may lead to loss of efficacy 1
2. Patients should be instructed to rotate injection sites between thigh and abdomen 2
3. Adalimumab can be taken out of the refrigerator for 15-30 minutes before injection to allow the solution to reach room temperature 2
4. Efficacy data shows approximately 80% of patients achieve PASI 75 at 12 weeks 1, significantly higher than the 35.5% response rate with methotrexate 5

By following this dosing regimen and monitoring protocol, patients with moderate to severe plaque psoriasis can achieve optimal disease control with adalimumab therapy.