Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Adalimumab is an injectable protein that blocks the inflammatory effects of tumor necrosis factor alpha (TNF alpha) in rheumatoid arthritis,
psoriatic arthritis, ankylosing spondylitis, and Crohn 's
disease of the intestine. Inflammation is the body's reaction to injury and is a necessary process for the repair of injury. TNF is a protein that the body produces when there is inflammation. The TNF promotes inflammation and the signs of inflammation, which, in the case of arthritis, include
fever as well as pain, tenderness, and swelling of joints. In the case of
Crohn's disease, the signs of inflammation include fever, abdominal pain, and diarrhea. The unchecked inflammation of rheumatoid arthritis eventually leads to destruction of the joints. The inflammation in Crohn's disease can lead to strictures (narrowing) of the intestine or intestinal perforation. .Adalimumab is a synthetic (man-made) protein, similar to human protein, that binds to TNF in the body and thereby blocks the effects of TNF. As a result, inflammation and its consequences in the joints and intestine are reduced. In arthritis, the progressive destruction of the joints is slowed or prevented. Adalimumab was approved by the FDA in December, 2002.
STORAGE: Adalimumab should be refrigerated at 2-8°C (36-46°F).
PRESCRIBED FOR: Adalimumab
is used for reducing the
signs
and symptoms of
rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease. It also slows the progression (destruction of the joints) and improves physical function (in adults) in moderate to severe rheumatoid arthritis. It is used after one or more other drugs that slow the destruction of the joints (referred to as disease modifying, anti-rheumatic drugs or DMARDs) have failed. In arthritis, adalimumab can be used alone or in combination with methotrexate or other
DMARDs. Adalimumab is used similarly (alone
or in combination with DMARDS) for the treatment of ankylosing spondylitis, psoriatic arthritis,and Crohn's disease.
DOSING: Adalimumab is injected under the skin.
The recommended dose for adults is 40 mg every other week, but some patients may
need weekly administration.
DRUG INTERACTIONS:
Methotrexate reduces the absorption of adalimumab by 29-49%, but no adjustments
to the dose of adalimumab need to be made when methotrexate is given concomitantly. Serious infections are more likely to occur when adalimumab is combined with anakinra
(Kineret).
PREGNANCY: Adalimumab has not been adequately studied in pregnant women.
NURSING MOTHERS: Use of adalimumab by nursing mothers has not been adequately evaluated.
SIDE EFFECTS: The most common side effects are headache, rash, nausea and stomach upset. Adalimumab may cause swelling, redness, pain and itching at the site of injection . Adalimumab suppresses the immune system and is therefore associated with minor infections of the urinary tract, respiratory tract and sinuses. Like other drugs that block TNF, use of adalimumab also has been associated with serious infections such as tuberculosis, sepsis (bacteria in the blood) and fungal infections. Individuals with active infections should not be treated with adalimumab. Adalimumab also may worsen the symptoms of diseases of the nervous system. In studies some patients who used adalimumab or other TNF blocking drugs developed cancer. Since patients
with rheumatoid arthritis have a higher rate of cancers than the general
population, the connection between cancer and use of adalimumab is
unclear. Other side effects of adalimumab include hypersensitivity reactions (including anaphylaxis) and reduced levels in the blood of platelets and red cells (aplastic anemia).
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Sarcoidosis is a disease that results from a specific type of inflammation of
tissues of the body. It can appear in almost any body organ, but it starts most
often in
the lungs or lymph nodes.
The cause of sarcoidosis is unknown. The disease can
appear suddenly and disappear. Or it can develop gradually and go on
to produce symptoms that come and go, sometimes for a lifetime.
As sarcoidosis progresses, microscopic lumps of a specific form of inflammation, called granulomas, appear in the affected tissues. In the majority of cases, these granulomas
clear up, either with or without treatment. In the few cases where the
granulomas do not heal and disappear, the tissues tend to remain inflamed and
become scarred (fibrotic).
Sarcoidosis was first identified over 100 years ago by
two dermatologists working independently, Dr. Jonathan Hutchinson in England and
Dr. Caesar Boeck in Norway. Sarcoidosis was o...
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