What is adalimumab?
Adalimumab (brand name Humira) is the most widely prescribed biologic medication in the world. It is used to treat a broad range of inflammatory conditions including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, Crohn’s disease, ulcerative colitis, uveitis, and hidradenitis suppurativa.
Several biosimilars are now available, including Hadlima, Hyrimoz, Cyltezo, and Amjevita, among others. Your insurance may prefer a biosimilar — this is perfectly fine. Biosimilars are not generic drugs. They are highly similar biological products that have undergone rigorous testing to confirm they work the same way and are equally safe and effective as the original.
How it works
Adalimumab is a TNF inhibitor. It targets a protein called tumor necrosis factor-alpha (TNF-alpha), a key driver of inflammation in autoimmune diseases. When your immune system overproduces TNF-alpha, it fuels the joint pain, swelling, skin lesions, or gut inflammation that characterize these conditions.
Adalimumab is a fully human monoclonal antibody — it binds directly to TNF-alpha and blocks it from activating inflammatory pathways. By neutralizing excess TNF, it helps bring your immune system back toward balance.
How to take it
- 40 mg subcutaneous injection every 2 weeks is the most common dose (some conditions may require weekly dosing)
- Self-administered at home using a prefilled syringe or autoinjector pen
- Store in the refrigerator — remove and let it warm to room temperature for approximately 30 minutes before injecting
- Rotate injection sites between the thigh and abdomen (at least 2 inches from the navel)
- Never inject into skin that is bruised, red, hard, or tender
What to expect when starting
Improvement typically begins within 2–4 weeks, with the full effect usually reached by 3 months. Some patients notice relief sooner, particularly with pain and stiffness.
For rheumatoid arthritis, adalimumab is often combined with methotrexate. This combination is more effective than either drug alone and also reduces your body’s chance of forming antibodies against adalimumab (which can make the drug less effective over time).
Side effects to watch for
Common:
- Injection site reactions — redness, itching, swelling, or mild pain at the injection site. These usually improve within the first few weeks. Rotating sites and using a cold pack can help.
Important — contact us if you experience:
- Fever, chills, or any signs of infection (sore throat, cough, burning with urination, a wound that isn’t healing)
- Unusual fatigue or feeling generally unwell
- New numbness, tingling, or vision changes (very rare neurological side effect)
- New or worsening heart failure symptoms (shortness of breath, leg swelling)
Important: Adalimumab reduces part of your immune defense against infections. Most patients do well, but infections should be taken seriously. Call us early — don’t wait to see if it gets better on its own.
Required screening before starting
Before your first dose, we will check:
- TB screening (QuantiFERON blood test or PPD skin test) — TNF inhibitors can reactivate latent tuberculosis
- Hepatitis B screening — TNF inhibitors can reactivate dormant hepatitis B infection
- Baseline blood work including CBC and metabolic panel
- Review of your vaccination history — certain vaccines should be given before starting
Things to avoid
- Live vaccines — including live shingles vaccine (Zostavax), live nasal flu spray, and MMR. Inactivated vaccines (flu shot, COVID, Shingrix) are safe and recommended. Talk to us before any vaccination.
- Other biologics — adalimumab should not be taken with another biologic medication. Combining biologics significantly increases infection risk without meaningful added benefit.
- Don’t ignore infections — if you develop signs of infection, contact us. We may advise holding a dose until the infection resolves.
Frequently asked questions
What’s the difference between Humira and a biosimilar? Biosimilars are manufactured to be highly similar to the original biologic. They go through extensive testing to confirm equivalent safety and effectiveness. The main difference is usually cost. If your insurance requires a switch to a biosimilar, you can expect the same clinical results.
What if I develop antibodies to adalimumab? Some patients develop anti-drug antibodies over time, which can reduce the medication’s effectiveness. Taking methotrexate alongside adalimumab significantly lowers this risk. If the drug stops working, your rheumatologist can check antibody levels and adjust your treatment plan.
What if I miss a dose? Take it as soon as you remember, then resume your regular schedule. Do not take two doses at once.
Can I take adalimumab during pregnancy? TNF inhibitors are generally considered low risk in pregnancy, especially during the first two trimesters. However, always discuss family planning with your rheumatologist before becoming pregnant so we can plan the safest approach for you and your baby.
Are there rare but serious risks I should know about? Like all TNF inhibitors, adalimumab carries rare risks including reactivation of latent TB or hepatitis B (which is why we screen before starting), very rare cases of demyelinating disease, and a theoretical small increase in lymphoma risk — though the background rate of lymphoma is already elevated in patients with active inflammatory disease like RA. For the vast majority of patients, the benefits of controlling disease activity far outweigh these rare risks.
Can I travel with adalimumab? Yes. Keep it in an insulated cooler bag with ice packs. Adalimumab can stay at room temperature (up to 77°F / 25°C) for up to 14 days. Do not return it to the refrigerator once it has reached room temperature.
This handout is for informational purposes and does not replace the advice of your physician. Always follow the specific instructions given to you by your rheumatologist. If you have questions or concerns about your medication, contact Synergy Rheumatology & Wellness.