Recommended Dosing Frequency for Humira (Adalimumab)
The standard dosing frequency for Humira (adalimumab) in adults is 40 mg administered subcutaneously every other week for most indications, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. 1
Standard Dosing by Indication
- Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis: 40 mg subcutaneously every other week 1
- Plaque Psoriasis and Adult Uveitis: Initial dose of 80 mg, followed by 40 mg every other week starting one week after the initial dose 1
- Crohn's Disease (Adults): 160 mg initially on Day 1 (given in one day or split over two consecutive days), followed by 80 mg two weeks later (Day 15), then 40 mg every other week starting on Day 29 1
- Hidradenitis Suppurativa (Adults): Initial dose of 160 mg (given in one day or split over two consecutive days), followed by 80 mg two weeks later (Day 15), then 40 mg weekly or 80 mg every other week starting on Day 29 1
Pediatric Dosing
- Juvenile Idiopathic Arthritis or Pediatric Uveitis (weight-based dosing for patients 2 years and older) 1:
- 10 kg to <15 kg: 10 mg every other week
- 15 kg to <30 kg: 20 mg every other week
- 30 kg and greater: 40 mg every other week
Dose Adjustment Considerations
- Some patients with rheumatoid arthritis not taking concomitant methotrexate may benefit from increasing the dosage to 40 mg every week or 80 mg every other week 1
- For psoriasis patients, adalimumab is administered as 80 mg at week 0,40 mg at week 1, then every other week thereafter 2
- In patients with juvenile idiopathic arthritis-associated uveitis, adalimumab dose can be escalated 8 weeks after initiation if uveitis remains uncontrolled or if unable to begin tapering steroids after 4 weeks 2
Monitoring Requirements
Prior to initiating Humira, patients should be evaluated for active tuberculosis and tested for latent infection 1
Baseline monitoring should include 3:
- Tuberculosis testing (PPD)
- Complete blood count (CBC)
- Liver function tests (LFT)
- Hepatitis B screening in appropriate clinical settings
- Evaluation for demyelinating diseases and congestive heart failure
Ongoing monitoring during treatment 3:
- Periodic history and physical examination
- Yearly tuberculosis testing
- Regular CBC and liver function tests
Administration Guidelines
- Humira is intended for use under the guidance and supervision of a physician 1
- After proper training, patients may self-inject or have a caregiver administer the injection 1
- Injections should be given at separate sites in the thigh or abdomen, rotating injection sites 1
- If a dose is missed, it should be administered as soon as possible, then resume the regular scheduled dosing 1
Efficacy Considerations
- In clinical trials, adalimumab has shown significant efficacy when administered every other week 2
- For psoriasis, 80% of patients achieve PASI-75 (75% improvement in Psoriasis Area and Severity Index) at 12 weeks with the standard dosing regimen 2
- Long-term results show 68% of patients maintain PASI-75 at 60 weeks 2
Important Considerations and Pitfalls
- Adalimumab can be combined with methotrexate or other DMARDs to increase efficacy when necessary, particularly in psoriatic arthritis 2
- Avoid using adalimumab with live vaccines 3
- Contraindicated in patients with active, serious infections 3
- Use with caution in patients with congestive heart failure, particularly NYHA class III/IV CHF 3
- Patients with class I/II congestive heart failure should undergo echocardiogram testing before starting therapy 3