What can I take instead of Humira?

In this article:

• What can I take in place of Humira?
• Top 5 Humira alternatives
• Natural alternatives to Humira
• How to switch to a Humira alternative

In this article

• What can I take in place of Humira?
• Top 5 Humira alternatives
• Natural alternatives to Humira
• How to switch to a Humira alternative

Humira (adalimumab) is a brand-name prescription biologic drug that is administered by an under-the-skin injection. A type of lab-made protein that targets specific parts of the immune system, used to treat several autoimmune conditions, including rheumatoid arthritis, Crohn’s disease, and plaque psoriasis. It is typically self-administered at home once every two weeks or once weekly. When cost, effectiveness, or side effects become a concern, several alternatives to Humira are available. 

What can I take in place of Humira?

Humira was the first human monoclonal antibody FDA approved for rheumatoid arthritis in 2003 and has since received approval for several additional conditions. Other tumor necrosis factor (TNF) inhibitors (drugs that reduce inflammation by blocking a protein called TNF) that work similarly include Remicade (infliximab), Simponi (golimumab), Cimzia (certolizumab), and Enbrel (etanercept). 

Humira biosimilars can also serve as an alternative. Biosimilars are drugs that are highly similar to a brand-name biologic but not identical. They work the same way and are generally less expensive. Ten Humira biosimilars are currently FDA approved, some of which have their own lower-priced generic versions.

Other biologic medications that work differently from TNF inhibitors may also serve as alternatives. Traditional disease-modifying antirheumatic drugs (DMARDs) are another option, often prescribed early in the treatment of conditions like rheumatoid arthritis. 

Top 5 Humira alternatives

Cyltezo and other Humira biosimilars

Of the 10 FDA-approved Humira biosimilars, only three have been approved as fully interchangeable products: Cyltezo (adalimumab-adbm), Abrilada (adalimumab-afzb), and Simlandi (adalimumab-ryvk). A fully interchangeable biosimilar can be substituted for Humira without requiring a new prescription, using the same dosage and carrying the same warnings. Both Cyltezo and Simlandi have lower-priced generic versions available.

Even among the three interchangeable biosimilars, there are important differences that pharmacists and prescribers should be aware of, including whether the product contains latex, a concern for people with latex allergies. Biosimilars that are not fully interchangeable may also differ in administration technique, concentration, and dosage.

The remaining Humira biosimilars include Amjevita (adalimumab-atto), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvb).

Methotrexate

Oral methotrexate is traditionally the first-line DMARD for rheumatoid arthritis. If there is an inadequate response after three to four months of optimized dosing, a different DMARD or biologic agent may be added or substituted. 

Methotrexate costs around $100 per month, making it significantly more affordable than biologic medications like Humira. However, it can cause side effects that some people find intolerable, including liver, kidney, and lung toxicity, as well as immunosuppression. Close laboratory monitoring is required when starting treatment, typically every two months.

Methotrexate can also cause gastrointestinal side effects such as nausea, vomiting, and diarrhea. Splitting the once-weekly dose into two or three doses given 12 hours apart may help reduce these effects. Methotrexate is not recommended for people with poor kidney function. 

Simponi (golimumab)

Like Humira, Simponi (golimumab) is a TNF inhibitor. It is typically used alongside methotrexate for rheumatoid arthritis but can serve as a standalone alternative to Humira for psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. Simponi is given as a once-monthly injection under the skin, or as an intravenous infusion administered by a healthcare professional in a monitored setting. Side effects are similar to those of Humira. 

Orencia (abatacept)

Orencia (abatacept) belongs to a different drug class from Humira, known as T-cell costimulation modulators, drugs that work by blocking the activation of T-cells (immune cells that drive inflammation) in the joints. It is approved for rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and psoriatic arthritis.

Orencia can be given as a flat-dose injection under the skin or as a weight-based intravenous infusion. Because it interacts with many other medications, a full medication review is recommended before starting treatment. Orencia can be added to traditional DMARDs for rheumatoid arthritis, but should not be combined with a TNF inhibitor like Humira, as doing so significantly increases the risk of serious and potentially fatal infections.

Xeljanz (tofacitinib)

Xeljanz (tofacitinib) belongs to a class of drugs called Janus kinase (JAK) inhibitors, which work by blocking the JAK enzyme, a protein involved in signaling that drives joint and tissue inflammation. Xeljanz is FDA approved to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polyarticular juvenile idiopathic arthritis, and ulcerative colitis.

It is available as an oral tablet taken twice daily (immediate-release) or once daily (extended-release). Regular monitoring is required throughout treatment, including blood cholesterol levels, white blood cell counts (lymphocytes and neutrophils), liver function, and kidney function. Dose adjustments or discontinuation may be recommended based on lab results.

Xeljanz carries the risk of serious side effects. Clinical trials found that the higher dose of 10 mg twice daily was associated with a higher risk of death (including sudden cardiovascular death) and blood clots in people with rheumatoid arthritis ages 50 and older with at least one cardiovascular risk factor, compared to the 5 mg dose or a TNF inhibitor like Humira. As an immunosuppressant, appropriate screening is required before starting treatment.

Natural alternatives to Humira

For moderate to severe inflammatory conditions, there are no true natural alternatives to Humira or other prescription medications. However, some complementary approaches may help manage symptoms alongside prescribed treatment.

Probiotics and prebiotics may support the management of Crohn’s disease and ulcerative colitis. Certain micronutrient deficiencies are also common in inflammatory bowel diseases, including iron, B12, vitamin D, vitamin K, folic acid, selenium, zinc, and vitamins B1 and B6. Anti-inflammatory supplements such as fish oil, cayenne pepper, and turmeric may also be helpful. Aloe vera gel has also shown promising results in small studies for managing ulcerative colitis, though larger trials are needed to confirm its effectiveness. People taking immunosuppressing medications should adopt healthy lifestyle practices to reduce the risk of infection.

RELATED: The best natural remedies for arthritis | The 6 best exercises for arthritis

How to switch to a Humira alternative

With biosimilars now widely available, insurance formularies may be changed to prefer an interchangeable biosimilar over brand-name Humira. State laws on substitution vary, and prescriber notification is not always required. People switching to a biosimilar should be aware that differences in administration, dosing, storage, and indications can exist between products, even among interchangeable ones. If your insurance company switches your medication at the pharmacy, ask the pharmacist or your healthcare provider about the change and whether it is appropriate for you. 

Never stop taking Humira abruptly without medical guidance. Stopping a biologic can cause the body to develop antibodies against it, meaning if the drug is restarted, it may no longer be effective. Withdrawal effects have also been reported with abrupt discontinuation. Most conditions treated by Humira and its alternatives are chronic and will require lifelong treatment. Always consult a healthcare provider before making any changes to your treatment plan.

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