Pronunciation:

ay-da-LIM-ue-mab - atto

Brand Names:

• Amjevita

Dosage Forms:

• Solution

Warnings:

Patients treated with adalimumab-atto are at increased risk of infection, some of which may become serious and lead to hospitalization or death. These infections have included TB, invasive fungal infections, bacterial, viral, and those caused by opportunistic pathogens including Legionella and Listeria. The risks and benefits of therapy should be carefully considered prior to treatment initiation in patients with chronic or recurrent infection. Evaluate for latent TB and treat if necessary prior to initiating therapy. Monitor patients closely for signs and symptoms of infection during and after treatment, including the possible development of TB in patients who tested negative prior to treatment. Consider empirical antifungal therapy in at-risk patients who develop severe systemic illness. Lymphoma and other malignancies, some fatal, have been reported in pediatric and adolescent patients treated with tumor necrosis factor (TNF) blockers, including adalimumab products. Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), usually fatal, have been reported in patients treated with TNF blockers including adalimumab products, primarily in adolescent and young adult males with Crohn disease and ulcerative colitis. Most cases occurred in patients receiving concomitant treatment with azathioprine or 6-mercaptopurine .

Classifications:

Therapeutic—

Antirheumatic

Pharmacologic—

Adalimumab

Uses of This Medicine:

Adalimumab-atto injection is used to treat the symptoms and prevent the progression of moderate to severely active rheumatoid arthritis and active ankylosing spondylitis. It is used in children 2 years of age and older for juvenile idiopathic arthritis. This medicine is also used to treat psoriatic arthritis, which is a type of arthritis that causes pain and swelling in the joints along with patches of scaly skin on some areas of the body. Psoriatic arthritis usually occurs with a skin condition called psoriasis. Adalimumab-atto may be used alone or in combination with medicines (eg, methotrexate).

Adalimumab-atto injection is also used to treat moderate to severe active Crohn’s disease. It is also used to treat moderate to severe ulcerative colitis in patients who have been treated with other medicines (eg, azathioprine, corticosteroids, or 6-mercaptopurine) that did not work well.

Adalimumab-atto injection is also used to treat moderate to severe chronic plaque psoriasis, which is a skin disease with red patches and white scales that do not go away. It is given to patients who may receive other types of treatment, including pills, injection, or phototherapy (light treatment). It is also used to treat moderate to severe hidradenitis suppurativa, a chronic skin disease that causes small, painful lumps under the skin. This medicine is also used to treat non-infectious intermediate, posterior, and panuveitis.

This medicine is available only with your doctor’s prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of adalimumab-atto injection for the treatment of juvenile idiopathic arthritis in children 2 years of age and older and for the treatment of Crohn's disease in children 6 years of age and older. However, safety and efficacy have not been established in children younger than 2 years of age or weighing less than 10 kilograms (kg) for juvenile idiopathic arthritis, in children younger than 6 years of age for Crohn's disease, and in children for other conditions.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of adalimumab-atto injection in the elderly. However, this medicine may cause serious infections and cancer more often in the elderly, which may require caution in patients receiving adalimumab-atto injection.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abatacept
• Adenovirus Vaccine
• Anakinra
• Anifrolumab-fnia
• Bacillus of Calmette and Guerin Vaccine, Live
• Baricitinib
• Cholera Vaccine, Live
• Cyclosporine
• Dengue Tetravalent Vaccine, Live
• Ebola Zaire Vaccine, Live
• Infliximab
• Influenza Virus Vaccine, Live
• Levoketoconazole
• Measles Virus Vaccine, Live
• Methotrexate
• Mumps Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Rilonacept
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Smallpox Monkeypox Vaccine, Live Non-Replicating
• Smallpox Vaccine
• Theophylline
• Typhoid Vaccine, Live
• Varicella Virus Vaccine, Live
• Vedolizumab
• Warfarin
• Yellow Fever Vaccine
• Zoster Vaccine, Live

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood problems (eg, aplastic anemia, pancytopenia, thrombocytopenia), history of or
• Congestive heart failure or
• Guillain-Barré syndrome, history of or
• Infections (fungal, bacterial), history of or
• Leukopenia (low number of white blood cells) or
• Multiple sclerosis or
• Optic neuritis (eye problem) or
• Psoriasis (skin disease)—Use with caution. May make these conditions worse.

• Cancer, active or history of or
• Chronic obstructive pulmonary disease (COPD) or
• Granulomatosis polyangiitis—Use with caution. May increase the chance of getting new cancers.

• Diabetes or
• Hepatitis B, history of or
• Opportunistic infections, history of or
• Tuberculosis, history of—May increase chance for side effects.

• Infection, active—Should not be used in patients with this condition.

• Tuberculosis, active—Should be treated first before receiving this medicine.

Proper Use of This Medicine:

This medicine is given as a shot under your skin in the thighs or stomach. It may sometimes be given at home to patients who do not need to be in the hospital or clinic. If you are using this medicine at home, your doctor or nurse will teach you how to prepare and inject the medicine. Be sure that you understand how to use the medicine.

This medicine comes with a Medication Guide and patient Instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you use this medicine at home, you will be shown the body areas where this shot can be given. Use a different body area each time you give yourself or your child a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems. Do not inject into skin areas that are red, bruised, tender, hard, or scaly, or areas with scars or stretch marks. If you have psoriasis, do not inject into a raised, thick, red, or scaly skin patch or into skin lesions.

This medicine is available in 2 forms. You may use a prefilled SureClick® autoinjector or a prefilled syringe.

Allow 15 to 30 minutes for the medicine to warm up to room temperature. Do not warm it in any other way. Do not remove the needle cover while allowing the medicine to reach to room temperature. Remove it before use.

Check the liquid in the prefilled syringe or autoinjector. It should be clear and colorless to slightly yellow. Do not use it if it is cloudy, discolored, or has particles in it. Do not shake. Do not use the prefilled syringe or autoinjector if it has been cracked or broken.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For injection dosage forms (autoinjector or prefilled syringe):
  • For Crohn’s disease:
    • Adults and children 6 years of age and older weighing 40 kilograms (kg) or more—At first (Day 1), 160 milligrams (mg) injected under the skin in divided doses. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg is given at week 4 (Day 29) and every other week thereafter.
    • Children 6 years of age weighing 17 to less than 40 kg—At first (Day 1), 80 mg injected under the skin. Then 2 weeks later (Day 15), a dose of 40 mg is given. A maintenance dose of 20 mg is given at week 4 (Day 29) and every other week thereafter.
    • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For hidradenitis suppurativa:
    • Adults—At first (Day 1), 160 milligrams (mg) injected under the skin. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg is given every week or 80 mg every other week at week 4 (Day 29).
    • Children—Use and dose must be determined by your doctor.
  • For juvenile idiopathic arthritis:
    • Children 2 years of age and older—Dose is based on body weight and must be determined by your doctor.
      • Weighing 30 kilograms (kg) or more—40 milligrams (mg) injected under the skin every other week.
      • Weighing 15 kg to less than 30 kg—20 mg injected under the skin every other week.
      • Weighing 10 kg to less than 15 kg—10 mg injected under the skin every other week.
    • Children younger than 2 years of age or weighing less than 10 kg—Use and dose must be determined by your doctor.
  • For plaque psoriasis or uveitis:
    • Adults—At first, 80 milligrams (mg) injected under the skin, then 40 mg 1 week after the initial dose and every other week thereafter.
    • Children—Use and dose must be determined by your doctor.
  • For psoriatic arthritis, rheumatoid arthritis, or ankylosing spondylitis:
    • Adults—40 milligrams (mg) injected under the skin every other week. Your doctor may adjust your dose if needed.
    • Children—Use and dose must be determined by your doctor.
  • For ulcerative colitis:
    • Adults—At first (Day 1), 160 milligrams (mg) injected under the skin in divided doses. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg is given at week 4 (Day 29) and every other week thereafter.
    • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store in the refrigerator. Do not freeze.

Keep it in its original container. Protect the from light. Do not use it if it has been frozen or thawed. If needed (eg, traveling), you may also store the medicine at room temperature for up to 14 days. Throw away any unused medicine after 14 days.

Throw away used syringes or pens in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using This Medicine:

It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

You or your child will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.

Adalimumab-atto can temporarily lower the number of white blood cells in your blood, which may increase the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you or your child think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you or your child notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Do not take other medicines unless they have been discussed with your doctor. Using abatacept (Orencia®) or anakinra (Kineret®) together with this medicine may increase your risk of having serious side effects.

This medicine may cause other unwanted effects that may not occur until months or years after this medicine is used. A small number of people (including children and teenagers) who have used this type of medicine have developed certain types of cancer (eg, leukemia). Some patients also developed a type of cancer called lymphoma. Talk with your doctor if you or your child have unusual bleeding, bruising, or weakness, swollen lymph nodes in the neck, underarms, or groin, or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.

Adalimumab-atto may cause serious allergic reactions (eg, anaphylaxis, angioneurotic edema), which can be life-threatening and require immediate medical attention. Check with your doctor right away if you or your child have a cough, difficulty swallowing, dizziness, fast heartbeat, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs, rash, itching, trouble breathing, or unusual tiredness or weakness after using this medicine.

Check with your doctor right away if you or your child has swelling of the face, fingers, feet, or lower legs, sudden weight gain, or trouble breathing. These may be signs of a heart condition called congestive heart failure (CHF).

Some people who have used this medicine developed lupus-like symptoms during treatment and got better after the medicine was stopped. Check with your doctor right away if you or your child start having chest pains, trouble breathing, joint pain, or a rash on your cheeks or arms that is sensitive to the sun.

Do not have any live vaccines (immunizations) while you or your child are being treated with adalimumab-atto. Your child’s vaccines need to be current before he or she begins using adalimumab-atto. Be sure to ask your child’s doctor if you have any questions about this.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Bladder pain

body aches or pain

bloody or cloudy urine

chest tightness

chills

cough

difficult, burning, or painful urination

ear congestion

fever

frequent urge to urinate

headache

hoarseness or other voice changes

lower back or side pain

pain or tenderness around the eyes and cheekbones

sneezing

sore throat

stuffy or runny nose

sweating

trouble breathing

unusual tiredness or weakness

Less common

Black, tarry stools

blindness

blue or pale skin

bone fractures

confusion

dark urine

decreased vision

difficulty with moving

dizziness

eye pain

fainting

fast, slow, or irregular heartbeat or pulse

hoarseness

increased thirst

increased urination

itching, skin rash

indigestion

light-colored stools

loss of appetite

loss of strength or energy

muscle cramps, pain, spasms, or stiffness

nausea

nervousness

pain in the arms or legs

pounding in the ears

seizures

slow or fast heartbeat

sores, ulcers, or white spots on the lips or in the mouth

stomach pain

trouble thinking

unpleasant breath odor

unusual bleeding or bruising

vomiting

vomiting of blood

yellow eyes or skin

Incidence not known

Blistering, peeling, or loosening of the skin

decreased urine output

dilated neck veins

diarrhea

irregular breathing

irregular heartbeat

joint pain

numbness or tingling in the fingers, face, or feet

red, irritated eyes

red skin lesions, often with a purple center

swelling of the face, fingers, feet, or lower legs

weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Back pain

bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

Incidence not known

Hair loss or thinning of the hair

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.