Adalimumab Treatment Guidelines

Introduction to Adalimumab Regimen

The American Academy of Dermatology recommends a standard regimen for adalimumab, starting with 80 mg subcutaneously at week 0, followed by 40 mg at week 1, and then 40 mg every other week thereafter as maintenance therapy, for patients with moderate-to-severe plaque psoriasis 1, 2
For better disease control in some patients, a maintenance dose of 40 mg weekly may be considered, particularly for those with moderate-to-severe plaque psoriasis, palmoplantar psoriasis, nail psoriasis, or scalp psoriasis 1

The American Academy of Dermatology suggests that adalimumab efficacy can be enhanced through combination therapy with topical therapies, such as high-potency corticosteroids with/without vitamin D analogues (Strength of recommendation B) 1
Combination therapy with methotrexate is particularly beneficial for reducing immunogenicity, increasing effectiveness, and reducing clearance of adalimumab, with a strength of recommendation B 1, 2
Combination therapy with acitretin may augment efficacy for moderate-to-severe plaque psoriasis, with a strength of recommendation C 1
Combination therapy with narrowband ultraviolet phototherapy can enhance efficacy, with a strength of recommendation B 1

For patients with inadequate response to standard dosing, increasing to 40 mg weekly may improve disease control, with strong evidence (Strength of recommendation A) 1, 2
The standard regimen of 40 mg every other week may be combined with methotrexate for reduced immunogenicity, increased effectiveness, and reduced clearance of adalimumab 2
For rheumatoid arthritis, the recommended dose is 40 mg subcutaneously every other week, as stated by the American Academy of Dermatology 3, 4
For Crohn's disease, the dose is 160 mg at week 0, 80 mg at week 2, and then 40 mg every other week starting at week 4, as recommended by the American Academy of Dermatology 3, 4
For juvenile rheumatoid arthritis, weight-based dosing is approved for children as young as 4 years, according to the American Academy of Dermatology 3, 4
For ankylosing spondylitis, the dose is 40 mg every other week, as stated by the American Academy of Dermatology 3, 4

Tuberculosis screening before initiation and periodic monitoring during treatment, including clinical assessment and yearly TB testing, are recommended 1
Baseline laboratory tests, such as complete blood count, liver function tests, and hepatitis profile, should be performed before starting adalimumab therapy 1
Interrupted therapy should be avoided as it may result in loss of efficacy, lower response rate upon restarting therapy, and poorer disease control 2
Serious infections, including tuberculosis and opportunistic infections, have been reported, as stated by the American Academy of Dermatology 3
Rare reports of malignancies, autoimmune reactions, and neurological concerns have been documented, according to the American Academy of Dermatology 3
Potential exacerbation or new onset of congestive heart failure and moderately painful injection site reactions may occur, as reported by the American Academy of Dermatology 3

Development of anti-adalimumab antibodies can reduce efficacy, and consideration of methotrexate co-administration to reduce antibody formation is recommended 2
Adalimumab can be combined with topical therapies, such as topical steroids and vitamin D analogues, as recommended by the American Academy of Dermatology 1
Methotrexate can be combined for psoriatic arthritis to reduce immunogenicity and increase effectiveness, according to the British Association of Dermatologists 2
Acitretin can be added in palmoplantar psoriasis to increase efficacy without increasing immunosuppression, as stated by the American Academy of Dermatology 1
Adalimumab has a pregnancy category B rating, indicating it may be safer than some other biologics during pregnancy, though careful risk-benefit assessment is still required, as reported by the American Academy of Dermatology 3
Continuous therapy is recommended as interrupted therapy may result in loss of efficacy, according to the British Association of Dermatologists 2
Clearance is better maintained with continuous use, and there is potential loss of efficacy after restart, as stated by the American Academy of Dermatology 3
Periodic history and physical examination while on treatment, consider yearly PPD testing, and periodic CBC and LFT are necessary, according to the American Academy of Dermatology 3

For psoriasis, 80% of patients achieve PASI-75 at 12 weeks, and 68% maintain PASI-75 at 60 weeks, as reported by the American Academy of Dermatology 3