Adalimumab Therapy: Clinical Findings and Implications for Integration into Clinical Guidelines for Rheumatoid Arthritis

Adalimumab (Humira) is the first fully human monoclonal anti-tumor necrosis factor (TNF) antibody available. Similar to the other TNF-alpha blockers, adalimumab has been shown to effectively reduce the symptoms and signs of rheumatoid arthritis and prevent the progression of erosive joint changes seen on radiological examination, which would lead to disabling joint damage. Clinical guidelines recommend the use of TNF blockers, specifically etanercept and infliximab (the only two available when the guidelines were issued) as treatment options for adults with rheumatoid arthritis who continue to have clinically active disease that has not responded adequately to two conventional disease-modifying antirheumatic drugs (DMARDs). The clinical results available using adalimumab, and summarized in this review, reveal a clinical profile similar to etanercept and infliximab, achieving similarly high response rates, suppression of joint damage, and improvements in quality of life and disability, together with a good safety profile. Being a fully human monoclonal antibody, adalimumab may induce less antigenicity than these other agents, which might also be advantageous in maintaining the level of effectiveness. However, direct comparisons in controlled, long-term trials are needed to draw conclusions about which agent to try first in the sequence of DMARDs considered for patients.