2 The technology
2.1 Adalimumab (Humira, Abbott Laboratories) is a recombinant human monoclonal antibody that binds specifically to tumour necrosis factor alpha (TNF-α), blocking interaction with its cell-surface receptors and thereby limiting the promotion of inflammatory pathways. It has a marketing authorisation for the treatment of moderate to severe chronic plaque psoriasis in adult patients who failed to respond to or who have a contraindication to, or are intolerant to, other systemic therapy including ciclosporin, methotrexate or PUVA. The recommended dosage for adalimumab is an initial 80 mg dose administered by subcutaneous injection, followed by 40 mg given subcutaneously every other week starting 1 week after the initial dose. Adalimumab is available in two presentations: a prefilled syringe and an autoinjection pen. For further information, see the summary of product characteristics (SPC).
2.2 Common adverse events associated with adalimumab, as reported in the SPC, include injection-site reactions, infections, dizziness, headache, diarrhoea, abdominal pain, stomatitis and mouth ulceration, nausea, increased hepatic enzymes, musculoskeletal pain and fatigue. Contraindications listed in the SPC include active tuberculosis or other severe infections such as sepsis, opportunistic infections and moderate to severe heart failure. For full details of side effects and contraindications, see the SPC.
2.3 Adalimumab costs £357.50 per 40 mg prefilled syringe or prefilled autoinjection pen (excluding VAT; 'British national formulary' [BNF] edition 55). The average annual cost per patient of adalimumab is estimated by the manufacturer to be £10,010 in the first year and £9295 in subsequent years. Costs may vary in different settings because of negotiated procurement discounts.