Prior to initiating HADLIMA and periodically during therapy, evaluate patients for active tuberculosis and test for latent infection.
• Rheumatoid Arthritis
• Psoriatic Arthritis
• Ankylosing Spondylitis
40 mg subcutaneously every other week
MTX, other nonbiologic DMARDs, glucocorticoids, NSAIDs, and/or analgesics may be continued during treatment with HADLIMA. In the treatment of rheumatoid arthritis, some patients not taking concomitant MTX may derive additional benefit from increasing the dosage of HADLIMA to 40 mg every week or 80 mg every other week.
• Crohn’s Disease
Day 1: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days)
Day 15: 80 mg subcutaneously
Day 29: 40 mg subcutaneously every other week
In patients with Crohn’s disease, aminosalicylates and/or corticosteroids may be continued during treatment with HADLIMA. Azathioprine, 6-MP (for more information, see the Warnings and Precautions section of the Prescribing Information), or MTX may be continued during treatment with HADLIMA if necessary.
• Ulcerative Colitis
Day 1: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days)
Day 15: 80 mg subcutaneously
Day 29: 40 mg subcutaneously every other week
In patients with ulcerative colitis, discontinue HADLIMA in adult patients without evidence of clinical remission by 8 weeks (day 57) of therapy. Aminosalicylates and/or corticosteroids may be continued during treatment with HADLIMA. Azathioprine and 6-MP (for more information, see the Warnings and Precautions section of the Prescribing Information) may be continued during treatment with HADLIMA if necessary.
• Plaque Psoriasis
• Uveitis
Initial dose: 80 mg subcutaneously
1 week after initial dose: 40 mg subcutaneously every other week
The use of adalimumab products in moderate to severe chronic plaque psoriasis beyond 1 year has not been evaluated in controlled clinical trials.
• Hidradenitis Suppurativa
Initial dose: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days)
Day 15: 80 mg subcutaneously
Day 29: 40 mg subcutaneously weekly or 80 mg subcutaneously every other week
DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; NSAIDs, nonsteroidal anti-inflammatory drugs.
6-MP, 6-mercaptopurine.
HADLIMA is indicated, alone or in combination with methotrexate or other non-biologic disease-modifying antirheumatic drugs (DMARDs), for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis.
HADLIMA is indicated, alone or in combination with methotrexate, for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older.
HADLIMA is indicated, alone or in combination with non-biologic DMARDs, for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis.
HADLIMA is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis.
HADLIMA is indicated for the treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older.
HADLIMA is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients.
Limitations of Use:
HADLIMA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. HADLIMA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.
HADLIMA is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients.
HADLIMA is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adult patients.
Patients treated with adalimumab products, including HADLIMA, are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
Discontinue HADLIMA if a patient develops a serious infection or sepsis.
Reported infections include:
Carefully consider the risks and benefits of treatment with HADLIMA prior to initiating therapy in patients:
Monitor patients closely for the development of signs and symptoms of infection during and after treatment with HADLIMA, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.
MALIGNANCY
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including adalimumab products. Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers, including adalimumab products. These cases have had a very aggressive disease course and have been fatal. The majority of reported TNF blocker cases have occurred in patients with Crohn’s disease or ulcerative colitis and the majority were in adolescent and young adult males. Almost all of these patients had received treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants.
HYPERSENSITIVITY
Anaphylaxis and angioneurotic edema have been reported following adalimumab administration. If a serious allergic reaction occurs, stop HADLIMA and institute appropriate therapy.
HEPATITIS B VIRUS REACTIVATION
Use of TNF blockers, including HADLIMA, may increase the risk of reactivation of hepatitis B virus (HBV) in patients who are chronic carriers. Some cases have been fatal.
Evaluate patients at risk for HBV infection for prior evidence of HBV infection before initiating TNF blocker therapy.
Exercise caution in patients who are carriers of HBV and monitor them during and after HADLIMA treatment.
Discontinue HADLIMA and begin antiviral therapy in patients who develop HBV reactivation. Exercise caution when resuming HADLIMA after HBV treatment.
NEUROLOGIC REACTIONS
TNF blockers, including adalimumab products, have been associated with rare cases of new onset or exacerbation of central nervous system and peripheral demyelinating diseases, including multiple sclerosis, optic neuritis, and Guillain-Barré syndrome.
Exercise caution when considering HADLIMA for patients with these disorders; discontinuation of HADLIMA should be considered if any of these disorders develop.
HEMATOLOGIC REACTIONS
Rare reports of pancytopenia, including aplastic anemia, have been reported with TNF blockers. Medically significant cytopenia has been infrequently reported with adalimumab products.
Consider stopping HADLIMA if significant hematologic abnormalities occur.
CONGESTIVE HEART FAILURE
Worsening and new onset congestive heart failure (CHF) has been reported with TNF blockers. Cases of worsening CHF have been observed with adalimumab products; exercise caution and monitor carefully.
AUTOIMMUNITY
Treatment with adalimumab products may result in the formation of autoantibodies and, rarely, in development of a lupus-like syndrome. Discontinue treatment if symptoms of a lupus-like syndrome develop.
IMMUNIZATIONS
Patients on HADLIMA should not receive live vaccines.
Pediatric patients, if possible, should be brought up to date with all immunizations before initiating HADLIMA therapy.
Adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in utero-exposed infant. The safety of administering live or live-attenuated vaccines in infants exposed to adalimumab products in utero is unknown. Risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants.
ADVERSE REACTIONS
The most common adverse reactions in adalimumab clinical trials (>10%) were: infections (eg, upper respiratory, sinusitis), injection site reactions, headache, and rash.
Before prescribing HADLIMA, please read the Prescribing Information, including the Boxed Warning about serious infections and malignancies. The Medication Guide and Instructions for Use also are available.