Adalimumab in the Treatment of Immune-Mediated Diseases

Abstract

Tumour necrosis factor (TNF) plays an important role in the pathogenesis of immune-mediated inflammatory diseases (IMIDs). TNF inhibition results in down-regulation of abnormal and progressive inflammatory processes, resulting in rapid and sustained clinical remission, improved quality of life and prevention of target organ damage. Adalimumab is the first fully human monoclonal antibody directed against TNF. In this article, we review the role and cost effectiveness of adalimumab in the treatment of IMIDs in adults and children. The efficacy and tolerability of adalimumab has been demonstrated in patients with a wide range of inflammatory conditions, leading to regulatory approval in rheumatoid arthritis (RA), psoriatic arthritis (PsA), plaque psoriasis, inflammatory bowel diseases (Crohn's disease, ulcerative colitis, paediatric Crohn's disease, and intestinal Beheet's disease), ankylosing spondylitis (AS), axial spondyloarthritis (SpA) and juvenile idiopathic arthritis. The major tolerability issues with adalimumab are class effects, such as injection site reactions and increased risk of infection and lymphoma. As with all anti-TNF agents, adalimumab is immunogenic, although less than infliximab, and some patients receiving long-term adalimumab will develop anti-drug antibodies, causing a loss of response. Comparisons of its clinical utility and cost effectiveness have shown it to be a valid treatment choice in a wide range of patients. Recent data from Italian economic studies show the cost effectiveness

Adalimumab for the treatment of refractory active and inactive non-infectious uveitis

“…Adalimumab (Humira, AbbVie, Chicago, Illinois, USA) is a completely human monoclonal IgG1 TNF-α antibody that was first approved by the US Food and Drug Administration (FDA) for the treatment of rheumatoid arthritis in 2002. It has since gained approval for use in patients with psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, Crohn’s disease, chronic plaque psoriasis and juvenile idiopathic arthritis 7. Following two randomised placebo-controlled trials VISUAL-18 and VISUAL-2,9 adalimumab has now been approved for the treatment of adults with non-infectious intermediate, posterior and panuveitis by the European Medicines Agency10 and the FDA,11 although international experts suggest that adalimumab may also be useful in children and patients with anterior uveitis 12…”

Exogenous IFN-beta regulates the RANKL-c-Fos-IFN-beta signaling pathway in the collagen antibody-induced arthritis model

“…Disease-modifying anti-rheumatic drugs, such as methotrexate, are one of the most common types of treatments. Other efficient anti-rheumatic drugs have recently been developed, including biological response modifiers such as tumor necrosis factor (TNF)-α blockers [4,5]. However, the clinical use of these therapies is limited because of their adverse effects and high cost.…”

Calpain-2 Inhibitor Therapy Reduces Murine Colitis and Colitis-associated Cancer

“…26,27 Inflammatory cytokines such as TNFα have been shown to increase in intestinal tissues and peripheral phagocytes of patients with IBD. 28 This has led to the development of monoclonal antibodies against TNF-α for treating inflammation in IBD and other inflammatory disorders, 29 although some patients do not respond to this treatment and other inflammatory mediators may contribute to this effect. 8,30 …”