Rheumatology and

Musculo-skeletal Clinic

 
 
 

Humira



Humira is a biological agent with a humanised antibody against TNF.  It is used as a disease modifying anti-rheumatic drug.


Humira is supplied to patients in a sterile syringe containing 40 mg of active drug, and is generally given once a fortnight, sub-cutaneously.


There are no known interactions with regards to kidney or liver impairment, but clearance is delayed in patients taking methotrexate.  (This is used as a desired effect).  Dose adjustment has not been required in patients taking either methotrexate, or other medications.  No recommendation is currently available for patients with liver or kidney impairment.


Adverse Effects


Humira is contraindicated (not permitted) in patients with active infection, sepsis, active tuberculosis, and opportunistic infections.  If a patient has an infection they must not have their next dose of Humira until the infection is cleared.  Please contact the rheumatologist, (or have your GP contact the rheumatologist) if you have an infection, while on Humira, as there is an increased risk for serious and life-threatening infections while on Humira.  There is a significant need for early admission to hospital if you develop an infection while on Humira.  If in doubt seek advice straight away from your GP or rheumatologist.


Hypersensitivity reaction.  Please stop the Humira, and see your GP for appropriate therapy, and contact the rheumatologist looking after you if you develop any signs of a rash or itching, swelling of the neck or throat, or large raised lumps, while on Humira.  Hypersensitivity is uncommon (approximately 1%), and can cause a rash, angioedema (swelling of the tongue, or neck), and anaphylaxis (life threatening reaction) and needs attention straight away.


Tuberculosis and hepatitis B.  Reactivation of Tb and hepatitis B has been observed in patients on Humira.  If you suspect that you have developed Tb or hepatitis B then please ask your GP to call the rheumatologist looking after you.


Neurologic events.  Demyelinating disorders (weakness and numbness in fingers and toes) have been described in patients on Humira.


Haematological (Blood) abnormalities have been infrequently reported, and it is uncertain whether there is a causal relationship.  If you develop a low platelet count, or white cell count, (your GP will measure these every month), then please get your GP to advise the rheumatologist.


Cancers.  There is an observed small increased risk of lymphoma in rheumatoid patients. Humira patients also have an increased risk of Lymphoma compared with the general population.  It is unknown if this is equal to the background risk increase in patients with rheumatoid arthritis, or if this is due to the role of TNF blockade (the way Humira works).  There has been no evidence so far for an increase in solid tumours, although a theoretical risk exists.


Vaccinations.  Live vaccines should not be given to patients on Humira


Congestive heart failure (CHF).  Worsening of CHF has been observed in some patients taking Humira.  Patients who develop shortness of breath or swelling in the legs need to see their GP, and may need to have the Humira stopped.


Auto-immunity.  Humira may result in the formation of antibodies which rarely induce a lupus-like syndrome (rash, joint aches, and abnormal blood tests).


Pregnancy (category C).  The use of Humira in pregnancy is not recommended, as there is insufficient data for pregnancy.  So far there has been no observed increase in deformed babies.  Adequate contraception is recommended for all women taking Humira, and for up to one month following the stopping of Humira.


Breast feeding.  It is unknown whether Humira is excreted in milk, or absorbed by babies after they drink the milk.  Although, not recommended, the patient’s circumstances should be considered.  If in doubt discuss it with the rheumatologist.


Overdosage.  The maximum tolerated dose has not been determined in humans.  In case of overdosage it is recommended that the patient be observed by a doctor for signs of adverse reactions, and appropriate symptomatic treatment instituted.


Other biologics now available in New Zealand include Infliximab, Etanercept, Tocilizumab, and Rituximab.  More are becoming available each year.  All have a risk of serious infection although other side effects are more specific to each agent.