Most of us can say that our lives are already stressful enough. Between juggling work, family life, and new regulations around a pandemic, we don’t need to worry about having additional uncertainty or interruptions added to our “new normal.”
For many people with autoinflammatory diseases like arthritis, plaque psoriasis, Crohn’s disease, and ulcerative colitis, dealing with a “surprise” flare-up can definitely feel like an unwelcome interruption.
Humira can provide needed comfort and certainty for people with autoinflammatory diseases during these uncertain times. While Humira is not a cure for autoinflammatory diseases, it can be used to safely manage these conditions and decrease the severity of flare-ups when they do occur. Here, we will discuss how Humira works for various autoinflammatory diseases, how to use it safely, and in what dosages. We will also talk about important drug interactions and side effects to be aware of.
What is Humira, and what is it used for?
Humira is the brand name for the drug adalimumab. It’s in a larger class of drugs called disease modifying anti-rheumatic agents (DMARDs) and is in a subclass of DMARDs called “biologics.” Biologics are drugs that are made from components of living (or biologic) cells. Humira is a prescription drug manufactured by AbbVie. It is not available over the counter.
Humira works by specifically blocking TNF-alpha and was approved for use by the FDA in 2002. Tumor necrosis factor (TNF) blockers are immunosuppressive drugs (also called immunosuppressants). By blocking the activity of TNF—a substance in the body that causes inflammation—Humira can be used to treat inflammatory autoimmune diseases such as arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis. Humira, like most DMARDs, usually takes between several weeks to several months to start working. It is not an NSAID (non-steroidal anti-inflammatory drug) or corticosteroid (steroid).
Since biologics contain complex components, they are not easy to reproduce or make an exact, generic copy of. With no generic options available, the FDA recognizes the need for similar drugs to exist and has encouraged competitors to manufacture alternative options. A drug that is similar to a biologic that is already FDA approved is called a “biosimilar” drug. There are currently seven Humira biosimilars approved by the FDA: Hulio, Hadlima, Abrilada, Tremfya, Amjevita, Cyltezo, and Hyrimoz. Even though these biosimilars have been approved by the FDA, they will not be available in the United States until 2023, as Humira is patent-protected until then.
Humira is used for the management of a variety of inflammatory autoimmune diseases. By blocking TNF-alpha activity, Humira reduces inflammation and painful symptoms associated with the following conditions.
Humira for inflammatory or rheumatoid arthritis: An overactive immune system can cause inflammation in the joints, creating symptoms like pain, swelling, and stiffness of the joint. TNF-alpha is one of the proteins involved in causing uncomfortable joint inflammation. Humira targets and blocks the activity of TNF-alpha in the joints, which reduces the symptoms and slows the progression of joint damage. Another drug commonly used to treat inflammatory arthritis is methotrexate. In clinical studies, people taking Humira plus methotrexate have shown a significant improvement in symptoms of active rheumatoid arthritis over taking methotrexate alone.
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Humira for plaque psoriasis: While the exact cause is unknown, having too much TNF-alpha can alter the growth of skin cells, leading to red, flaky patches. By decreasing the amount of TNF-alpha circulating in the body, Humira can decrease and sometimes even eliminate plaque lesions on the skin.
Humira for psoriatic arthritis: Psoriatic arthritis is a type of arthritis that affects some people who already have psoriasis. An excess of TNF-alpha in some individuals can trigger joint pain, swelling, and stiffness, as well as red, scaly patches on the skin called plaques. Humira can help control these flare-ups by blocking the activity of excess TNF-alpha.
Humira for ankylosing spondylitis: Ankylosing spondylitis is an inflammatory arthritis of the spine. Excess TNF-alpha induced inflammation contributes to back pain and stiffness in people with ankylosing spondylitis. Humira can reduce the symptoms for adult patients with active ankylosing spondylitis.
Humira for Crohn’s disease: Crohn’s disease symptoms like diarrhea, abdominal pain, and cramping can appear without warning. When your body produces too much TNF-alpha, it can cause excess inflammation that will trigger these and other Crohn’s disease symptoms. Humira can help by eliminating the excess inflammation.
Humira for ulcerative colitis: Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It is chronic and long-lasting, causing inflammation in the large intestine (colon), and rectum. The exact cause of the inflammation is unknown. However, help is available. Humira has been shown to reduce or eliminate symptoms of ulcerative colitis such as frequent and urgent diarrhea, weight loss, nausea, and tiredness.
Humira for hidradenitis suppurativa: Hidradenitis suppurativa (HS) is a chronic skin condition where painful lumps occur under the skin. These painful lumps occur under gland-bearing skin in the armpits, groin, buttocks, or breasts. Having too much TNF-alpha is believed to contribute to the severity of HS. Humira can help by blocking the TNF-alpha protein, which can reduce the inflammation and pain under the skin.
Humira for uveitis: Uveitis is inflammation of the delicate tissue in the eye called the uvea. Infectious uveitis caused by an infection from a virus or bacteria. Non-infectious uveitis is a chronic inflammation of the uvea not caused by a virus or bacteria. Too much TNF-alpha along with other proteins contribute to the inflammation, pain, and sensitivity to light seen in non-infectious uveitis. Humira can decrease the inflammation in the eye, reducing the uncomfortable symptoms.
Humira for juvenile idiopathic arthritis: Children under the age of 16 with symptoms of persistent pain, swelling, or stiffness in the joints, may have juvenile idiopathic arthritis (JIA). When this happens in more than one joint, it is called polyarticular juvenile idiopathic arthritis. TNF-alpha is one of the contributors to the joint inflammation which causes the persistent pain, swelling, and stiffness. Humira blocks the activity of TNF-alpha. Another drug commonly used to treat JIA is methotrexate. In clinical studies, children treated with Humira and methotrexate have been shown to have significant improvement of symptoms over methotrexate alone.
How does Humira work?
Humira is a monoclonal antibody that specifically binds to TNF-alpha. TNF-alpha is a small type of protein called a cytokine. Cytokines are used by the immune system to cause inflammation. Normally, release of cytokines like TNF-alpha is how the immune system cells communicate with each other. When the immune system cells detect an infection, they release TNF-alpha to alert other cells in the body that an infection is present. This communication pathway causes the inflammation that is necessary for the body to kill the infection. In certain autoinflammatory diseases, TNF-alpha is released without an infection being present, causing inflammation in a variety of tissues in the body.
Drugs like Humira that specifically bind to TNF-alpha are called TNF-blocking agents. By binding to TNF-alpha, clinical studies have shown that Humira neutralizes—or blocks—the inflammatory activity of TNF-alpha. The drug also causes cells in the body that express too much TNF-alpha to die.
TNF-blocking agents are immunosuppressants. By blocking TNF in the body, Humira is suppressing—or decreasing the activity of—overactive or unwanted inflammatory activity in the immune system. Since Humira can decrease inflammation in the immune system, Humira can be used to treat inflammatory autoimmune diseases such as arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis. This also means Humira can suppress the immune system in general, making some people more vulnerable to infections.
How to take Humira
Humira is given as a subcutaneous (under the skin) injection. Injection drugs like Humira must be prescribed by a licensed healthcare professional. Humira dosing is based upon which condition it is being used to treat. It is important that the correct dosing schedule is followed for the condition Humira is being used to treat.
How quickly Humira starts working depends on a variety of factors, including the severity of the medical condition being treated and which condition Humira is being used to treat. Some people start to feel symptomatic relief with Humira after two weeks, but for others, it can take up to three months.
Humira is considered a maintenance (long-term) medication. It continues to provide symptom relief for as long as you are taking it. There is no set end-time for when you stop taking it. You will not experience “withdrawal” if you stop taking Humira, but your symptoms may reappear. Your healthcare provider will assess you at regular intervals to check on your inflammatory response as well as your response to Humira. You and your healthcare provider can decide when, or if, discontinuing Humira is appropriate. You should not stop taking Humira on your own without seeking medical advice.
Humira is dosed in two ways. When starting Humira, a starting dose is given. The starting dose should be injected by or under the supervision of a healthcare provider. It is important that proper injection technique is used. Proper injection technique can be demonstrated for you by your healthcare provider. “Good places to inject are going to be the abdomen (stay about an inch away from the belly button) and the sides of the thighs,” says Victoria Ruffing, RN, a nurse manager at Johns Hopkins.
After the starting dose, a series of maintenance doses are given. It is important to remember that the starting dose of Humira and the maintenance doses are not always the same. The maintenance doses can be self-injected in the comfort of your home. Your healthcare provider can demonstrate how to do the injections at home. There are also instructional materials your healthcare provider can give you for you to refer to when at home. Humira should not be injected on days that are not specified by the starting or maintenance doses.
|Humira adult dosing|
|Indication||Starting dose||Maintenance dose|
|Rheumatoid arthritis||40 mg on Day 1||40 mg every other week|
|Plaque psoriasis||80 mg on Day 1||40 mg on Day 8, and 40 mg every other week|
|Psoriatic arthritis||40 mg||40 mg every other week|
|Ankylosing spondylitis||40 mg on Day 1||40 mg every other week|
|Crohn’s disease||160 mg on Day 1 (given in one day or split between two consecutive days)||80 mg on Day 15, and 40 mg every other week starting on Day 29|
|Ulcerative colitis||160 mg on Day 1 (given in one day or split between two consecutive days)||80 mg on Day 15, and 40 mg every other week starting on Day 29|
|Hidradenitis suppurativa||160 mg on Day 1 (given in one day or split between two consecutive days)||80 mg on Day 15, and EITHER 40 mg every week starting on Day 29 OR 80 mg every other week starting on Day 29|
|Uveitis||80 mg on Day 1||40 mg on Day 8, and 40 mg every other week|
|Humira pediatric dosing|
|Indication||Starting dose||Maintenance dose|
|Juvenile idiopathic arthritis: children 2 years or older||
|Crohn’s disease: children 6 years or older||
|Ulcerative colitis: children 5 years or older||
|Hidradenitis suppurativa: children 12 years or older||
|Uveitis: children 2 years or older||
There are not any special conditions for when Humira is administered. It does not need to be injected around a certain time of day or activity (like meals). Most people prefer to inject Humira at a time that is consistent for them and fits into their daily schedule, like before bedtime or after breakfast. The use of calendars or phone apps can also be helpful by setting reminders for when maintenance injections should be administered.
If you miss a dose of Humira, inject the next dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take the next maintenance dose according to the dosing schedule.
Humira has a half-life (the time it takes a drug to lose half of its biological activity) of 10 to 20 days. Most drugs are completely eliminated from the body in four to five half-lives, so traces of Humira could be found in the body for up to 14 weeks after discontinuing use.
It is very rare to overdose on Humira. However, if you accidentally use too much Humira, call the Poison Control Center line immediately at 1-800-222-1222 or seek emergency medical services.
Humira comes in a prefilled syringe or a prefilled Humira Pen and must be stored in the refrigerator in its original container and protected from light until use. Humira should not be frozen, heated, or used after the expiration date. Do not use Humira if it has been frozen and thawed or heated in any way.
The Humira Pen or prefilled syringe can be taken out of the fridge 15 to 30 minutes before injection to allow the liquid to reach room temperature. Once at room temperature, Humira should still be protected from light and used within 14 days. Discard and do not use Humira if it has been at room temperature for longer than 14 days.
You should not try to warm Humira in any way (do not run it under hot water or put it in the microwave). Humira should not be used if the liquid is discolored or cloudy or has particles in it. Caution should be taken when handling the Humira Pen or prefilled syringe. They should not be crushed or dropped.
Humira safety information
- Humira is safe for adults and children older than 2, depending on the condition it is being used to treat.
- Humira can be used by women who are pregnant or breastfeeding after consideration of potential risks and benefits.
- Humira should not be taken by anyone with an active infection, or anyone who gets lots of infections. You should be tested for tuberculosis before starting Humira.
- Humira should not be taken by anyone with an allergy to any of the ingredients or components.
- People taking other drugs that suppress the immune system (see interactions) should discuss the risks and benefits with their healthcare provider.
- Before starting Humira, your healthcare provider may want to run some blood tests to check baseline blood function and levels of inflammation.
- People taking Humira should not receive live vaccines. Live vaccines include Flumist and the chicken pox vaccine. If you have received any of those vaccinations, be sure to inform your healthcare provider before starting Humira.
- After starting Humira, your healthcare provider should be notified right away if you get an infection or any signs of infection. People taking Humira have an increased risk for a variety of types of infection including potentially serious or fatal fungal infections.
- If you notice any worsening of symptoms after starting Humira, be sure to let your healthcare provider know.
- Some reports have suggested that using Humira can increase nervous system issues, including new onset multiple sclerosis.
- For children and adults taking Humira or other TNF-blockers, the chances of getting cancer may increase. There have been unusual cases of cancer including skin cancer and lymphoma in children, teenagers, and young adults taking TNF-blockers.
Common side effects of Humira include:
- Injection site reactions (pain, redness, rash, swelling, itching, bruising)
- Upper respiratory infections, sinus infections, and urine infections
- Joint, abdominal, or back pain
- High blood pressure
- Blood in the urine
- Liver or muscle enzyme elevation
- High cholesterol
Humira can also cause serious side effects, including:
- Serious infections like bacterial sepsis
- Hepatitis B infection in carriers of the virus
- Tuberculosis reactivation
- Allergic reactions (anaphylaxis, trouble breathing, hives, swelling in the face, lips, or mouth)
- Nervous system problems (signs include tingling or numbness, problems with vision, weakness in arms or legs, and dizziness)
- Blood problems (decreased blood cells that fight infection)
- Heart failure (symptoms include shortness of breath, swelling in ankles and feet, or sudden weight gain)
- Immune reactions including a lupus-like syndrome (symptoms include chest discomfort, shortness of breath, joint pain, or a rash on arms and cheeks that is worse in the sun)
- Liver problems (symptoms include feeling very tired, skin or eyes that look yellow, decreased appetite or vomiting, or pain on the right side of the abdomen), which can lead to liver failure or death
- Psoriasis (red scaly patches or raised bumps on the skin that may be filled with pus)
- Lung problems (interstitial lung disease or sarcoidosis)
- Blood vessel inflammation
- Cancer (including skin cancer, lymphoma, and leukemia)
- Autoimmune disease
Humira may have negative interactions with other drugs that weaken the immune system. People on other TNF-blockers like Remicade (infliximab), Orencia (abatacept), Kineret (anakinra), Enbrel (etanercept), Cimzia (certolizumab pegol), or Simponi (golimumab) should avoid taking these drugs and Humira at the same time. Notify your healthcare provider if you have ever taken Rituxan (rituximab), Imuran (azathioprine), or Purinethol (mercaptopurine, 6-MP) before starting Humira.
Humira may decrease the concentration of warfarin and the effectiveness of BCG.
There are no interactions with Humira and alcohol use.
There are no foods that need to be restricted when taking Humira.
Do you think Humira is right for you or your family but are worried about the cost? Humira is extremely expensive (more than $7,000 for a month’s supply). Fortunately, SingleCare has free coupons for Humira that you can use on every refill. Get coupons for Humira prefilled syringes here or coupons for Humira pens here.