Adalimumab

Adalimumab
Monoclonal antibody
Type Whole antibody
Source Human
Target TNF alpha
Clinical data
Trade names Humira, Mabura, Exemptia
AHFS/Drugs.com Monograph
MedlinePlus a603010
License data
Pregnancy
category
  • AU: C
  • US: B (No risk in non-human studies)
    Routes of
    administration    		 Subcutaneous
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability 64% (subcutaneous), 0% (oral)
    Elimination half-life 10–20 days.
    Identifiers
    CAS Number
    DrugBank
    ChemSpider
    • none
    UNII
    KEGG
    ChEMBL
    ECHA InfoCard 100.224.376 Edit this at Wikidata
    Chemical and physical data
    Formula C6428H9912N1694O1987S46
    Molar mass 144190.3 g/mol
     ☒N☑Y (what is this?)  (verify)

    Adalimumab, sold under the trade name Humira among others, is a medication used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, chronic psoriasis, hidradenitis suppurativa, and juvenile idiopathic arthritis. In rheumatoid arthritis, adalimumab has a response rate similar to methotrexate, and in combination, it nearly doubles the response rate of methotrexate alone.[1][2]

    Adalimumab is a TNF-inhibiting, anti-inflammatory, biologic medication. It binds to tumor necrosis factor-alpha (TNFα), which normally binds to TNFα receptors, leading to the inflammatory response of autoimmune diseases. By binding to TNFα, adalimumab reduces this inflammatory response. Because TNFα is also part of the immune system, which protects the body from infection, treatment with adalimumab may increase the risk of infections.

    Humira costs approximately $4370 per month (2017). From 2012 until the US patent expiry in 2016, Humira led the list of top-selling pharmaceutical products, and in 2016, it had $16 billion of global sales.[3] In 2014, in India, the first adalimumab biosimilar came to market at a price of $200. Two years later, another Indian drugmaker, Torrent Pharmaceuticals, launched a second biosimilar.[4] Humira's U.S. patent expired in 2016.[5]

    Medical uses

    Like other TNF inhibitors, it is an immunosuppresive medication, used to treat autoimmune diseases such as rheumatoid arthritis.

    Adalimumab is administered by subcutaneous injection.[6] For most indications, the maintenance treatment is an injection every other week.[6]

    Rheumatoid arthritis

    Adalimumab has been shown to reduce the signs and symptoms of moderate to severe rheumatoid arthritis (RA) in adults. It may be used alone or in combination with DMARDs.[7] It has also been shown to have efficacy in moderate to severe polyarticular juvenile idiopathic arthritis (JIA) in children 4 and older, and is approved for the treatment of that condition. In RA, it has been approved for use alone, or with methotrexate or similar medicines, in the U.S. since 2002.[8][9]

    Psoriatic arthritis

    In 2003, adalimumab began undergoing trials for use in treating psoriasis and psoriatic arthritis.[10]

    Ankylosing spondylitis

    Adalimumab has been shown to reduce the signs and symptoms of, and is approved for treatment of, ankylosing spondylitis in adults.[11]

    Crohn’s disease

    Adalimumab has been shown to reduce the signs and symptoms of moderate to severe Crohn's disease.[12] It has been approved for that use in the UK since 2009.[13]

    Ulcerative colitis

    Adalimumab may be effective and well tolerated in ulcerative colitis. It has been approved by the FDA for treatment of moderate to severe cases in adults.[14]

    Plaque psoriasis

    Adalimumab has been shown to treat moderate to severe chronic plaque psoriasis in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).[15] Adalimumab has been shown to be effective therapy when used either continuously or intermittently in patients with moderate to severe psoriasis.

    Hidradenitis suppurativa

    Adalimumab has been approved for hidradenitis suppurativa.[16]

    Juvenile idiopathic arthritis

    Adalimumab has been shown to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 and older.

    Side effects

    Components of a Humira autoinjector pen.

    Adalimumab suppresses TNFα, which is an important part of the immune system. Therefore, latent infections such as tuberculosis can be reactivated, and the immune system may be unable to fight new infections. This has led to fatal infections in some patients.[17]

    After a number of studies and reports of adverse events in patients receiving adalimumab—including serious and sometimes fatal blood disorders; serious infections, including tuberculosis, and infections caused by viruses, fungi, or bacteria; rare reports of lymphoma[18] and solid tissue cancers; rare reports of serious liver injury; rare reports of demyelinating central nervous system disorders; and rare reports of cardiac failure—the U.S. Food and Drug Administration (FDA) issued a black box warning to doctors, which appears in the product labeling of adalimumab and other TNF-inhibiting drugs, instructing them to screen and monitor potential patients more carefully.[19] Anaphylaxis or other serious allergic reactions may also occur.[19]

    History

    Adalimumab was the first fully human monoclonal antibody approved by the U.S. Food and Drug Administration. It was derived from phage display.[20]

    Adalimumab was discovered as a result of a collaboration between BASF Bioresearch Corporation and Cambridge Antibody Technology, U.K., itself a collaboration of the government-funded Medical Research Council and three academics, which began in 1993.[21]

    Initially named D2E7,[22] it was then further manufactured at BASF Bioresearch Corporation, developed by BASF Knoll (BASF Pharma), and ultimately manufactured and marketed by Abbott Laboratories after Abbott's acquisition of BASF Pharma. On January 1, 2013, Abbott split into two companies, one retaining the Abbott name and the other named AbbVie.[23] As a result, AbbVie took over development and marketing of Humira.[24] The brand name Humira stands for "human monoclonal antibody in rheumatoid arthritis".

    It was the third TNF inhibitor, after infliximab and etanercept, to be approved in the United States. It was constructed from a fully human monoclonal antibody, while infliximab is a mouse-human chimeric antibody and etanercept is a TNF receptor-IgG fusion protein.

    The drug candidate was discovered initially using CAT's phage display technology and named D2E7.[22] The key components of the drug were found by guiding the selection of human antibodies from phage display repertoires to a single epitope of an antigen TNF alpha.[25] The ultimate clinical candidate, D2E7, was created and manufactured at BASF Bioresearch Corporation and taken through most of the drug development process by BASF Knoll, then further development, manufacturing and marketing by Abbott Laboratories, after Abbott acquired the pharmaceutical arm of BASF Knoll.[26]

    As of 2008, adalimumab had been approved by the FDA for the treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, moderate to severe chronic psoriasis and juvenile idiopathic arthritis. Although only approved for ulcerative colitis from late 2012 by the FDA in the disease's management, it had been used for several years in cases that have not responded to conventional treatment at standard dosing for Crohn's disease.

    Marketing

    • 1999: Preliminary results of early clinical trials with the fully human anti-TNFα monoclonal antibody D2E7[22]
    • 2001, June: Results from ARMADA, a double-blind, placebo-controlled clinical trial involving 271 patients with active rheumatoid arthritis despite treatment with methotrexate are announced. Among the results are that 50% of patients show a 50% improvement in ACR score.[27]
    • 2002: Broke ground on a new state-of-the-art biologics manufacturing facility.[28]
    • 2002: Adalimumab results from five separate trials show that it is effective at reducing signs and symptoms of rheumatoid arthritis. In these studies, adalimumab had a rapid onset of action and sustained efficacy. Furthermore, adalimumab was safe and effective when given alone or in combination with MTX as a subcutaneous injection.[29]
    • 2002, December 31: Humira approved by the U.S. Food and Drug Administration (FDA) for treatment of rheumatoid arthritis.[28]
    • 2003: Launched Humira for rheumatoid arthritis and continued clinical studies for additional indications.[28]
    • 2005: Launched Humira for psoriatic arthritis. Exceeded $1 billion in annual sales for the first time.[28]
    • 2005, 10 December: Eisai Submits New Drug Application for Rheumatoid Arthritis Drug Adalimumab (D2E7) in Japan.[30]
    • 2006: Submitted Humira for the Crohn’s disease indication and launched it for AS. Exceeded $2 billion in annual sales.[28]
    • 2007: Launched Humira for Crohn’s disease in the United States,[28] submitted Humira for global regulatory approval for psoriasis — the fifth new Humira disease indication at this time, achieved more than $3 billion in worldwide Humira sales.[31]
    • 2007, 10 December: Abbott Opens New Biotechnology Manufacturing Facility in Puerto Rico[32]
    • 2008: Launched Humira for plaque psoriasis
    • 2009, 10 June: Five-Year Data Demonstrate Initial Use of Humira Plus Methotrexate May Prevent Further Joint Damage in Early Rheumatoid Arthritis Patients [33]
    • 2012, 16 March: Humira could be associated with a significant decrease in vascular inflammation, a major risk factor of cardiovascular disease [34]
    • 2013: Due to the split of Abbott, Humira rights are now owned by AbbVie.
    • 2014: Humira recognized by IMS Health as the "world's best selling drug."[35]
    • 2014: In December 2014, Indian drugmaker Cadila Healthcare declared the launch of the first adalimumab biosimilar at a fifth of its U.S. price. The generic has been launched under the brand name Exemptia.[36][37]
    • 2015: Launched Humira for moderate to severe hidradenitis suppurativa, an orphan indication. No other treatment has been rigorously tested and found to be safe and effective in treating this painful and scarring condition.
    • 2016: The best selling drugs list researched by Genetic Engineering & Biotechnology News, published in March 2017, details that Humira occupied the number 1 position for 2015 ($14.012 billion) and 2016 ($16.078 billion)[38]
    • 2017: Abbvie reports that Humira achieved $18.427 billion of sales in 2017.[39]

    Society and culture

    Royalty litigation

    In March 2003, Cambridge Antibody Technology (CAT) stated its wish to "initiate discussions regarding the applicability of the royalty offset provisions for Humira" with Abbott Laboratories in the High Court of London. In November 2004, the trial began, and in December 2004, Justice Hugh Laddie ruled for CAT.

    A short version of the full statement of the proceedings was released.[40] In it Justice Laddie remarked, "Abbott was in error when it made its first royalty payment to CAT calculated on the basis that only 2% of the Net Sales was due. It should have calculated on the basis of the full royalty of just over 5% and should have paid and continued to pay CAT accordingly." Justice Laddie went on to observe "...that the construction advanced by Abbott does violence to the language of the agreements, renders them obscure and makes little or no commercial sense. For this reason CAT wins the action."[41]

    Abbott was required to pay CAT US$255 million, some of which was to be passed to its partners in development.[42] Of this sum, the Medical Research Council received US$191M, and in addition, Abbott was asked to pay the MRC a further US$7.5M over five years from 2006, providing that Humira remains on the market. The MRC also is to receive a further £5.1M (sterling) in respect of past royalties.[43]

    Patent litigation

    On May 29, 2009, Johnson & Johnson's Centocor unit, the maker of Remicade (infliximab), won a ruling for $1.67 billion from Abbott Laboratories, the maker of Humira, for patent infringement on the process for making Humira.[44] However, in 2011 this judgment was overturned by the United States Court of Appeals for the Federal Circuit.[45]

    Biosimilars

    In December 2014, Indian drugmaker Cadila Healthcare declared the launch of the first adalimumab biosimilar at a fifth of its U.S. price. The generic has been launched under the brand name Exemptia.[5][46]

    In January 2016, Indian drugmaker Torrent Pharmaceuticals launched its biosimilar for adalimumab, called Adfrar. It was the second generic biosimilar of adalimumab.[4]

    In September 2016, the FDA approved American drugmaker Amgen's biosimilar, sold under the brand name Amjevita.[47]

    In August 2017, the FDA approved German pharmaceutical company Boehringer Ingelheim's biosimilar, Cyltezo.

    Similar agents

    References

    1. ↑ Adalimumab (Humira) for the Treatment of Rheumatoid Arthritis, BETH WELCH, Am Fam Physician. 2008 Dec 15;78(12):1406-1408.
    2. ↑ "Adalimumab - EyeWiki". eyewiki.aao.org. Retrieved 2018-09-02.
    3. ↑ "The Top 15 Best-Selling Drugs of 2016 - The Lists - GEN Genetic Engineering & Biotechnology News - Biotech from Bench to Business - GEN". GEN.
    4. 1 2 Reporter, B. S. (11 January 2016). "Torrent launches world's second biosimilar of generic auto-immune drug" – via Business Standard.
    5. 1 2 "India's Cadila launches first cheaper copy of world's top-selling drug". Reuters.
    6. 1 2 "Humira - Full prescribing information" (PDF).
    7. ↑ Navarro-Sarabia, F; Ariza-Ariza, R; Hernandez-Cruz, B; Villanueva, I (20 July 2005). "Adalimumab for treating rheumatoid arthritis". The Cochrane Database of Systematic Reviews (3): CD005113. doi:10.1002/14651858.CD005113.pub2. PMID 16034967.
    8. ↑ Siegel, Jay P., M.D., FACP. "Therapeutic Biologic Applications (BLA) – Humira Approval Letter 12/31/02". Center for Drug Evaluation and Research. Retrieved 2014-02-04.
    9. ↑ "Humira® (Adalimumab) - 2011023-Humira.pdf" (PDF). Retrieved 2014-02-04.
    10. ↑ Scheinfeld, N (2003). "Adalimumab (HUMIRA): a review". J Drugs Dermatol. 2 (4): 375–7. PMID 12884458.
    11. ↑ Maxwell, LJ; Zochling, J; Boonen, A; Singh, JA; Veras, MM; Tanjong Ghogomu, E; Benkhalti Jandu, M; Tugwell, P; Wells, GA (18 April 2015). "TNF-alpha inhibitors for ankylosing spondylitis". The Cochrane Database of Systematic Reviews. 4: CD005468. doi:10.1002/14651858.CD005468.pub2. PMID 25887212.
    12. ↑ Podolsky, Daniel K. (August 2002). "Inflammatory bowel disease". N Engl J Med. 347 (6): 417–29. doi:10.1056/NEJMra020831. PMID 12167685.
    13. ↑ Morey, Sheralyn. "World Pharmaceutical Market Outlook: UK – Summary of NICE Approvals in September 2009". Retrieved 2014-02-04.
    14. ↑ "FDA approves Humira to treat ulcerative colitis". U.S. Food and Drug Administration. Sep 28, 2012.
    15. ↑ Croom, Katherine F; McCormack, Paul L (2009). "Adalimumab". Am J Clin Dermatol. 10 (1): 43–50. doi:10.2165/0128071-200910010-00008. PMID 19170412.
    16. ↑ "FDA Clears Adalimumab (Humira) for Hidradenitis Suppurativa". Retrieved 13 October 2017.
    17. ↑ Karen M. Frank, et al, Investigation of the cause of death in a gene-therapy trial, New England Journal of Medicine 361:161, July 9, 2009
    18. ↑ "Archived copy". Archived from the original on 2011-07-10. Retrieved 2011-03-06.
    19. 1 2 FDA label – http://www.rxabbott.com/pdf/humira_medguide.pdf
    20. ↑ Brekke OH; Sandlie I (January 2003). "Therapeutic antibodies for human diseases at the dawn of the twenty-first century". Nat Rev Drug Discov. 2 (1): 52–62. doi:10.1038/nrd984. PMID 12509759.
    21. ↑ Cambridge Antibody Technology website
    22. 1 2 3 Kempeni J (January 1999). "Preliminary results of early clinical trials with the fully human anti-TNFα monoclonal antibody D2E7". Ann Rheum Dis. 58 (suppl 1): I70–2. doi:10.1136/ard.58.2008.i70. PMC 1766582. PMID 10577977.
    23. ↑ "Abbott MediaRoom - Press Releases". abbott.com.
    24. ↑ "AbbVie - Pharmaceutical Products". abbvie.com.
    25. ↑ Jespers LS, Roberts A, Mahler SM, Winter G, Hoogenboom HR (September 1994). "Guiding the selection of human antibodies from phage display repertoires to a single epitope of an antigen". Bio/Technology. 12 (9): 899–903. doi:10.1038/nbt0994-899. PMID 7521646.
    26. ↑ "Archived copy". Archived from the original on 2013-02-12. Retrieved 2012-12-09.
    27. ↑ http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/11-12-2001/0001613559&EDATE=
    28. 1 2 3 4 5 6 "Archived copy". Archived from the original on 2008-01-13. Retrieved 2009-07-27.
    29. ↑ Rau R (January 2002). "Adalimumab (a fully human anti-tumour necrosis factor α monoclonal antibody) in the treatment of active rheumatoid arthritis: the initial results of five trials". Ann Rheum Dis. 61 (Suppl 2): ii70–3. doi:10.1136/ard.61.suppl_2.ii70. PMC 1766697. PMID 12379628.
    30. ↑ "Eisai Submits New Drug Application for Rheumatoid Arthritis Drug Adalimumab (D2E7) in Japan". thefreelibrary.com.
    31. ↑ "Archived copy". Archived from the original on 2009-05-03. Retrieved 2009-07-27.
    32. ↑ "Archived copy". Archived from the original on 2009-05-30. Retrieved 2009-07-27.
    33. ↑ "Archived copy". Archived from the original on 2010-03-22. Retrieved 2009-07-27.
    34. ↑ "Treating psoriasis to prevent heart attacks and strokes".
    35. ↑ "Humira Lifts AbbVie 2.8% in Q2". Discovery and Development. Rockaway, New Jersey, United States. Associated Press. 25 July 2014.
    36. ↑ "Adalimumab Exemptia - Official Site from Exemptia India". www.exemptia.com.
    37. ↑ "India's Cadila launches first cheaper copy of world's top-selling drug". 9 December 2014 – via Reuters.
    38. ↑ "The Top 15 Best-Selling Drugs of 2016 - The Lists - GEN". GEN.
    39. ↑ "AbbVie Reports Full-Year and Fourth-Quarter 2017 Financial Results - AbbVie Newsroom". news.abbvie.com.
    40. ↑ http://www.chandb.com/MBE/assessment_041220_CaT_Abbott_judgement_summary.doc%5Bpermanent+dead+link%5D
    41. ↑ "Biotech firm wins royalty fight". BBC News. 2004-12-20. Retrieved 2010-04-23.
    42. ↑ Murray-, Rosie (2005-10-27). "Drug maker CAT surges after royalty settlement". The Daily Telegraph. London. Retrieved 2010-04-23.
    43. ↑ "Archived copy" (PDF). Archived from the original (PDF) on 2007-06-27. Retrieved 2009-07-20.
    44. ↑ "J&J Wins Record .67 Billion Verdict From Abbott (Update2)". Bloomberg. 30 June 2009.
    45. ↑ Centocor Ortho Biotech, Inc. v. Abbott Labs., 636 F.3d 1341 (Fed. Cir. 2011), reversing 669 F. Supp. 2d 756 (E.D. Tex. 2009).
    46. ↑ "Exemptia - Adalimumab - Adalimumab Biosimilar - Autoimmune - Rheumatoid Arthritis". exemptia.com.
    47. ↑ "FDA approves Amjevita, a biosimilar to Humira". September 23, 2016. Retrieved 27 September 2016.
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