Adalimumab

Humira® Adalimumab ADA
AbbVie AG
Human monoclonal IgG1 antibody, binds soluble and membrane-bound TNF-α
Plaque psoriasis in adults, in ETA, IFX, ADA, UST, SEC and IXE also psoriatic arthritis, in ETA: indicated from 6 years of age
Yes (Infliximab: in case of failure of a previous TNF inhibitor therapy)
Treatment of adult patients with severe psoriasis (Def. in USZ and Swiss S1 Guideline): PASI > 10 or BSA > 10 and/or DLQI > 10) in which UVB and PUVA or one of the following three systemic rapias (ciclosporin, methotrexate, acitretin) have shown no therapeutic success. In iximab, additional failure of another TNF blocker approved for psoriasis
Pre-filled syringe, pen
Blood count, liver enzymes, creatinine, U status, pregnancy test in urine, CRP/ ESR. Screening for HBV, HCV, HIV and tuberculosis including Rx thorax. Optional: ANA, HLA-Cw6 (personalized medicine as not yet validated response predictor for Ustekinumab)
Blood count, CRP, liver transaminases, creatinine, possibly β-HCG
Month 1, 3, then every 3 months
Month 1, 3, then every 3 months
s.c.
80 mg in week 0, 40 mg in week 1, then every 2 weeks 40 mg
4 - 8 weeks
Week 16: 71 - 79.6 % Week 24: 63.3 %
Week 16: 36.5 % Week 24: 45.7 %
21‘232.90 (22‘866.20)
Possible
PASI, (use PrecisePASI for greater accuracy once PASI < 10), DLQI after 10 and 24 weeks
6 - 46 %, association with clinical response
Absolute contraindications: Heart disease NYHA III-IV, active infections, live vaccinations, malignant tumors in the last 5 years, except treated epithelial tumors or cervical dysplasia, demyelinating diseases, unclear neurological conditions (including family history). Pregnancy and breastfeeding. Active HBV/Tbc infection. Relative contraindications: systemic lupus erythematosus. In IFX: Allergies to murine antibodies.
Local reactions at the injection site, rarely angioedema, vertigo, headache, fever, fatigue, bacterial and viral infections, cytopenia, elevated liver values, lu-pus-like syndrome, neurological symptoms including paraesthesia, multiple sclerosis, facial paresis, lymphoma, solid organ tumors, spinocellular carcinomas, malignant melanomas, paradoxical psoriasis
Yes, with simultaneous HBV therapy (start 3 months before anti-TNF therapy). HBV DNA and liver function every 2 months, together with gastroenterology. Best evidence with Etanercept
Yes, monitoring of liver function and HCV-RNA, therapy together with gastroenterology Best evidence with Etanercept
Possible, case-dependent decision, together with infectiology
Anakinra, Abatacept
Cancer risk is slightly increased for skin cancers, but not other tumors
Inj.
systemic