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Anti-TNF Monoclonal Antibody Pregnancy: Compatible in first and second trimester — adalimumab crosses placenta in third trimester (neonatal immunosuppression). Avoid live vaccines in infant for 6 months after birth if mother received adalimumab in third trimester.

Adalimumab (IBD)

Brand names: Humira, Amgevita (biosimilar), Hyrimoz (biosimilar)

Adult dose

Dose: Crohn's disease: 160mg SC (4×40mg) at week 0, 80mg at week 2, then 40mg every 2 weeks. Ulcerative colitis: same induction; maintenance 40mg every 2 weeks (some may require 40mg weekly in loss of response).
Route: Subcutaneous injection
Frequency: Every 2 weeks (maintenance); induction at weeks 0, 2
Max: 160mg induction dose; 40mg per maintenance dose (every 2 weeks)
Screen for latent TB (IGRA/Mantoux), hepatitis B/C, and varicella before starting. Update vaccinations. Biosimilars (Amgevita, Hyrimoz, Imraldi etc.) are interchangeable per NICE. Home self-injection after training. Pen or prefilled syringe available.

Paediatric dose

Route: Subcutaneous injection
Frequency: Every 2 weeks (maintenance)
Max: 40mg per maintenance dose
BNF for Children: ≥6 years Crohn's/UC: <40kg: 80mg week 0, 40mg week 2, then 20mg every 2 weeks. ≥40kg: 160mg week 0, 80mg week 2, then 40mg every 2 weeks. Source: BNF for Children 2024; ECCO Paediatric IBD Guidelines.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Avoid in active hepatitis B (reactivation risk). No dose adjustment otherwise.

Clinical pearls

  • TB screening mandatory before starting: IGRA (QuantiFERON-TB Gold) preferred; treat latent TB for ≥4 weeks before commencing adalimumab.
  • Antidrug antibodies (ADA): form in up to 25% of patients on monotherapy — co-prescribing immunomodulator (azathioprine or methotrexate) significantly reduces ADA formation and improves durability.
  • Loss of response: check trough level and anti-drug antibodies before escalating dose. If trough low + no ADA → dose intensify. If high ADA → switch mechanism (vedolizumab, ustekinumab).
  • NICE TA187 (Crohn's) / TA329 (UC): adalimumab recommended for moderate–severe IBD after failure of conventional therapy.

Contraindications

  • Active TB or serious active infection
  • Active moderate–severe heart failure (NYHA class III–IV)
  • Active hepatitis B
  • Live vaccines during treatment
  • Prior malignancy within 5 years (relative contraindication)

Side effects

  • Injection site reactions (erythema, pain, swelling)
  • Serious infections (TB reactivation, bacterial sepsis, fungal — opportunistic)
  • Malignancy risk (lymphoma, non-melanoma skin cancer — long-term)
  • Demyelinating disease (rare)
  • Anti-drug antibodies (immunogenicity — reduced by co-prescribing immunomodulator)
  • Lupus-like syndrome (anti-dsDNA antibodies — rare)

Interactions

  • Live vaccines: contraindicated during therapy and for 3–6 months after stopping
  • Anakinra / abatacept: increased serious infection risk — avoid combination
  • Methotrexate / azathioprine: reduces anti-drug antibody formation — often co-prescribed
  • Other biologics: avoid concurrent use

Monitoring

  • TB screening annually
  • FBC and LFTs every 6 months
  • Drug trough levels and anti-drug antibodies (if loss of response)
  • Signs of infection
  • Annual skin cancer surveillance

Reference: BNFc; BNF 90; NICE TA187 (Crohn's); NICE TA329 (UC); ECCO IBD Guidelines 2021; BSG Biologic Monitoring Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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