Adalimumab (IBD)

How it works

It binds tumour necrosis factor-alpha and neutralises its pro-inflammatory activity, reducing the mucosal inflammatory cascade that drives inflammatory bowel disease.

Prescribing in practice

• Screen for and treat latent tuberculosis and other serious infections (including hepatitis B) before starting, as anti-TNF therapy can reactivate them and increases overall infection risk.
• Avoid live vaccines during treatment and assess for heart failure and demyelinating disease, which may be worsened by TNF blockade.
• There is a recognised risk of malignancy including a rare hepatosplenic T-cell lymphoma when combined with thiopurines, so weigh combination immunosuppression carefully.

Monitoring

Monitor clinically and biochemically for infection, and review disease activity, inflammatory markers and treatment response in line with the specialist gastroenterology pathway.

Counselling the patient

• Report fever, persistent cough, night sweats or any sign of infection promptly.
• Self-injection technique and safe sharps disposal should be confirmed, and injections rotated between sites.
• Tell any healthcare professional you are on a biologic before vaccinations or surgery.

Evidence & guidelines

NICE technology appraisals support adalimumab for moderate-to-severe Crohn's disease and ulcerative colitis, and MHRA advice highlights tuberculosis and serious-infection risks with anti-TNF agents.