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Pharmacology · TNF inhibitors

Adalimumab !

A fully human antibody against TNF-α, injected under the skin, for rheumatoid arthritis, spondylitis, psoriasis and bowel disease. TB is checked first.

Updated 2026-11-01

  • Class: TNF inhibitors
  • Target: Tumour necrosis factor alpha (TNF-α), soluble and membrane-bound
  • ATC code: L04AB04
  • WHO Model List of Essential Medicines

The figure shows human TNF-α bound to the Fab fragment of adalimumab (the antibody's antigen-binding arm).

Target in 3D: Tumour necrosis factor alpha (TNF-α), soluble and membrane-bound. PDB structure 3WD5 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Adalimumab is a recombinant human IgG1 monoclonal antibody. It binds TNF-α with high affinity and stops it from reaching its p55 and p75 receptors (TNFR1 and TNFR2) on cell surfaces. It also binds membrane TNF and can lyse cells that carry it. Less TNF signalling means less synovial inflammation, fewer acute-phase reactants and slower bone erosion.

  1. Human IgG1 antibody binds TNF-α
  2. TNF cannot reach TNFR1 and TNFR2
  3. Less IL-1, IL-6 and leukocyte recruitment
  4. Inflammation and joint erosion fall

Pharmacokinetics

Absorption
Subcutaneous injection; absorbed slowly, peak after several days
Metabolism
Broken down like other antibodies (proteolysis); no liver enzyme interactions
Half-life
About two weeks

Indications

Adverse effects

Common

  • Injection-site redness, pain or swelling
  • Upper respiratory infections
  • Headache
  • Nausea
  • Rash

Contraindications

  • Active serious infection, including active tuberculosis
  • Hypersensitivity to adalimumab

Key interactions

Anakinra or abatacept
More serious infections without added benefit; not combined.
Live vaccines
Risk of infection by the vaccine strain; avoided during treatment.
Other immunosuppressants (glucocorticoids, methotrexate, azathioprine)
Additive risk of infection; azathioprine or mercaptopurine with a TNF blocker has been linked to hepatosplenic T-cell lymphoma.

What is monitored

  • Latent tuberculosis test before starting, and watch for active TB during and after treatment even if the test was negative
  • Hepatitis B screening before starting
  • Signs of infection at every visit
  • Skin checks for cancer

Administration and safety

  • Subcutaneous injection (pen or prefilled syringe), rotating sites; not into tender, bruised or hard skin.
  • Biosimilar products exist; the product name on the prescription and the device are checked before each dose.
  • Kept refrigerated and protected from light; never frozen.

Nursing care

  • Confirm that the latent TB test and hepatitis B screening are done (and treated if positive) before the first dose.
  • Do not give the dose during an active infection; report fever, cough, night sweats or weight loss.
  • Check that vaccines are up to date before starting; live vaccines are avoided during treatment.
  • Ask about heart failure and neurological disease before starting.

Pregnancy and breastfeeding

Human IgG1 crosses the placenta late in pregnancy; the safety of live vaccines in babies exposed in the womb is not known, so the baby's doctor is told.

Test yourself

Think of the answer, then tap the question to see it.

Why can adalimumab reactivate tuberculosis?

TNF-α is needed to keep granulomas intact; when it is blocked, contained mycobacteria can spread, often as extrapulmonary or disseminated TB.

How does adalimumab differ structurally from infliximab?

Adalimumab is fully human; infliximab is chimeric (mouse variable regions), so it is more immunogenic and is given as an infusion.

Which other biologics should not be combined with adalimumab?

Anakinra and abatacept: the combination raises serious infections without adding benefit.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Adalimumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - ADALIMUMAB- adalimumab-adaz injection, solution (DailyMed (U.S. National Library of Medicine), 2025); Altered Immunocompetence | Vaccines & Immunizations | CDC (Centers for Disease Control and Prevention (CDC), 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.