What are the common side effects after Adalimumab injection?

Adalimumab is a fully human anti-tumor necrosis factor alpha (TNF-α) monoclonal antibody. It is widely used in the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriasis, Crohn's disease, ulcerative colitis and other autoimmune diseases. Despite its significant clinical efficacy, as a biological agent, adalimumab may still cause a variety of side effects during use. Especially after injection, some patients may experience local or systemic reactions, which requires sufficient attention. Common side effects will be analyzed in detail below in terms of injection site reactions, infection risks, allergies and immune-related reactions.

1. Injection site reaction is one of the most common adverse reactions

Injection site reactions are one of the most common adverse reactions during the use of adalimumab. Since the drug is injected subcutaneously, some patients may experience local reactions such as erythema, swelling, pain, itching, induration, and burning sensation within 24-48 hours after injection. These symptoms are mostly mild to moderate and usually resolve spontaneously within a few days without requiring special treatment. A very small number of patients may experience persistent induration or skin atrophy at the injection site due to repeated injections. During the injection process, pay attention to changing the injection site, keeping the skin clean and dry, and using correct injection techniques to help reduce the occurrence of local discomfort.

2. Increased risk of infection is a core concern when using adalimumab

Because adalimumab is a TNF-α inhibitor, it can significantly inhibit the immune system's ability to clear pathogenic microorganisms, thereby increasing the risk of infection, especially latent or opportunistic infections. Common types of infections include upper respiratory tract infections, urinary tract infections, pneumonia, and skin infections. What needs special vigilance is that if patients receiving adalimumab have latent tuberculosis (LTBI), the tuberculosis may be activated due to immunosuppression. Therefore, a tuberculin skin test or IGRA test must be performed before treatment to confirm whether there is latent infection. If the result is positive, standard anti-tuberculosis treatment must be carried out before adalimumab is used. In addition, there are a few reports showing viral infections such as Candida, herpes zoster, and cytomegalovirus after using adalimumab, and some severe patients may even be complicated by sepsis or fatal infections.

3. Allergies and post-injection immune reactions require vigilance

Although adalimumab is a fully human antibody, allergic reactions may still occur in a small number of patients. Clinical manifestations may include severe reactions such as rash, urticaria, itching, shortness of breath, laryngeal edema, and even anaphylactic shock. Although such cases are rare, once they occur, the drug should be discontinued immediately and emergency treatment should be carried out. In addition, some patients may develop resistant antibodies to adalimumab (anti-adalimumab antibodies, ADA), which may not only cause injection reactions and general discomfort, but also reduce the efficacy of the drug, or even lead to complete loss of efficacy. In some cases, doctors may combine immunosuppressants such as methotrexate to reduce the formation of drug-resistant antibodies.

4. Other systemic side effects also require attention

In addition to the side effects noted above, adalimumab may affect other system functions. In terms of the nervous system, a very small number of patients may experience headaches, dizziness, abnormal sensations, or even trigger symptoms similar to demyelinating diseases (such as multiple sclerosis). There are reports in the cardiovascular field that the drug may induce congestive heart failure, and should be used with caution especially in patients with a history of heart failure. In addition, some patients also experience hematological or hepatobiliary system side effects such as abnormal liver function, elevated liver enzymes, leukopenia, and thrombocytopenia. At the psychological level, there are a few reports of patients experiencing depression, anxiety and even suicidal tendencies. This may be related to the indirect effects of the drug on the central nervous system and deserves close observation by clinicians during long-term medication.

In general, adalimumab is a biological agent with clear efficacy and high biocompatibility, but its side effects, especially injection reactions, infection risks and immune reactions, cannot be ignored. A comprehensive assessment should be conducted before use, including infection screening, basic immune function tests, etc. Regular monitoring is also required during use. For patients who experience adverse reactions, timely intervention or treatment plan adjustments should be made based on the nature and severity of the reaction. Patients should use medications in a standardized manner under the guidance of a doctor, and do not increase or decrease the dosage or stop medication on their own, so as not to affect the treatment effect or cause serious consequences.

Reference materials:https://www.drugs.com/donanemab.html