From the Guidelines
Adalimumab should be withheld before parotidectomy surgery, with the last dose given at the end of the dosing cycle for that specific medication, as recommended for biologic agents in patients undergoing elective surgery 1. The decision to withhold adalimumab is based on the increased risk of infection associated with the use of biologic agents, as demonstrated by meta-analysis and network meta-analysis 1. Although the provided guideline is specifically for patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty, the principle of withholding biologic agents before surgery can be applied to other surgical procedures, such as parotidectomy, to minimize the risk of infection. Key considerations include:
- The patient's ulcerative colitis disease activity and the risk of flare during the perioperative period
- The complexity of the surgical procedure and the potential for wound healing complications
- The need for close coordination between the surgeon, gastroenterologist, and patient to manage the risks and benefits of withholding adalimumab After surgery, adalimumab can usually be restarted once the surgical wound has shown good initial healing, typically 1-2 weeks post-operation, assuming no signs of infection or healing complications 1. During the perioperative period, the patient should be monitored for signs of ulcerative colitis flare, and temporary symptom management may be needed. It is essential to weigh the risks and benefits of withholding adalimumab on a case-by-case basis, considering the individual patient's circumstances and the potential consequences of infection or disease flare 1.
From the Research
Adalimumab and Surgery
- There is no direct evidence in the provided studies that addresses the need to stop adalimumab before parotidectomy surgery 2, 3, 4, 5, 6.
- The studies primarily focus on the efficacy and safety of adalimumab in treating ulcerative colitis, rather than its management in relation to surgical procedures.
- None of the studies mention parotidectomy or the specific consideration of stopping adalimumab before such a surgery.
General Considerations for Adalimumab and Surgery
- Adalimumab is an immunosuppressive medication, and its use may affect surgical outcomes or increase the risk of infections 4, 6.
- However, the decision to stop adalimumab before surgery would typically depend on various factors, including the type of surgery, the patient's overall health, and the risk of disease flare-ups.
- It is essential to consult with a healthcare provider to determine the best course of action for managing adalimumab therapy in the context of upcoming surgery.