What is the typical dosage and frequency of Adalimumab (adalimumab) administration?

Adalimumab Dosing and Frequency

Adalimumab is administered at 40 mg subcutaneously every 2 weeks for maintenance therapy across most indications, following an initial loading dose of 80 mg at week 0 and 40 mg at week 1 for psoriasis. 1

Standard Dosing by Indication

Psoriasis

• Loading phase: 80 mg subcutaneous injection at week 0 (given as 2 × 40 mg), followed by 40 mg at week 1 1
• Maintenance: 40 mg subcutaneous injection every 2 weeks 1
• This regimen achieves 80% PASI-75 response at 12 weeks and maintains 68% PASI-75 at 60 weeks 2

Rheumatoid Arthritis and Ankylosing Spondylitis

• Standard dosing: 40 mg subcutaneously every other week 3, 4
• Mean steady-state trough concentrations reach approximately 5 mcg/mL without methotrexate and 8-9 mcg/mL with concomitant methotrexate 3
• Can be administered as monotherapy or combined with methotrexate/DMARDs 2, 4

Psoriatic Arthritis

• Standard dosing: 40 mg subcutaneously every 2 weeks 1, 5
• Steady-state trough concentrations range from 6-10 mcg/mL without methotrexate and 8.5-12 mcg/mL with methotrexate 3

Crohn's Disease and Ulcerative Colitis

• Loading phase: 160 mg at week 0, followed by 80 mg at week 2 3
• Maintenance: 40 mg every other week, with option to escalate to 40 mg weekly if needed 3
• Mean trough concentrations reach approximately 12 mcg/mL after loading, with steady-state of 7-15 mcg/mL depending on frequency 3

Hidradenitis Suppurativa

• Loading phase: 160 mg at week 0, followed by 80 mg at week 2 3
• Maintenance: 40 mg every week (note: weekly dosing for this indication) 3

Uveitis

• Standard dosing: 40 mg every other week 3
• Mean steady-state concentration approximately 8-10 mcg/mL 3

Dose Escalation Strategies

When inadequate response occurs, consider dose escalation from 40 mg every other week to 40 mg weekly, particularly in obese patients or those experiencing disease relapse during the treatment cycle. 1

• This escalation may increase infection risk and should be reserved for insufficient primary response 1
• The 80 mg every other week regimen provides comparable exposure to 40 mg weekly 3
• For juvenile idiopathic arthritis-associated uveitis, escalation can occur 8 weeks after initiation if uveitis remains uncontrolled 2

Pharmacokinetic Considerations

• Bioavailability: 64% following subcutaneous administration 3
• Time to peak concentration: 5.5 days (131 ± 56 hours) 3
• Half-life: Approximately 2 weeks (10-20 days) 3
• Volume of distribution: 4.7-6.0 L 3
• Clearance: Approximately 12 mL/hour, with no evidence of changes over time with long-term use 3

Monitoring Requirements

Baseline Assessment

• Tuberculosis testing (PPD) 2, 6
• Complete blood count and liver function tests 2, 6
• Hepatitis B screening 2, 6
• Evaluation for demyelinating diseases and congestive heart failure 2, 6

Ongoing Monitoring

• Periodic history and physical examination 2, 6
• Yearly tuberculosis testing 2, 6
• Regular complete blood count and liver function tests 2, 6

Critical Safety Considerations

• Contraindicated in active serious infections 6
• Use with caution in congestive heart failure, particularly NYHA class III/IV 6
• Avoid with live vaccines 6
• Avoid in multiple sclerosis or demyelinating diseases 6
• Injection site reactions are common but generally mild to moderate 6