adalimumab (Mabura)

Anti-TNF-Alpha Associated Central Nervous System Demyelination. Drug-Induced Demyelination or Multiple Sclerosis Trigger? A Case Series.

Abutorabi-Zarchi Marzie M, Ziyaei Amin A, Ghane Davoud D

Adalimumab is a monoclonal antibody that targets TNF-α and is effective in treating several autoimmune disorders, including non-infectious uveitis; however, it has been associated with demyelinating lesions. This study presents two cases of CNS demyelination in patients who consumed adalimumab. First, an 18-year-old man presented with subacute lower-limb paresis over the past month. He had an 8-year history of uveitis, which was treated with adalimumab. The patient was initially treated with intravenous methylprednisolone, which resulted in improvement of the symptoms; however, the patient subsequently presented with new symptoms of left lower limb paresis and right homonymous hemianopia. MRI showed periventricular lesions, including two ill-defined tumefactive demyelinating lesions (TDLs) and a cervical cord lesion. Second, a 35-year-old woman with a six-year history of recurrent inflammatory uveitis, who had been treated with adalimumab every 2 weeks for the last 6 months, developed right-sided paresthesia and mild weakness. MRI showed classic periventricular "Dawson's fingers" and a short-segment lesion in the cervical spinal cord. This study demonstrates the diagnostic challenges of demyelination following administration of anti-TNF-α agents. Persistence or recurrence of disease activity after discontinuation of adalimumab, along with fulfillment of MS diagnostic criteria, may favor an underlying demyelinating disease rather than a monophasic drug-induced process. This study emphasizes the importance of careful consideration before prescribing anti-TNF-α agents, particularly in patients with risk factors for demyelinating disease.

Biologic and targeted synthetic therapies in ankylosing spondylitis: a pharmacological review.

Ameer Omar Z OZ, Temsah Reem R, Alsouss Yara O YO, Al-Amoudi Raghad R et al.

Ankylosing spondylitis (AS) is a prototypical axial spondyloarthritis (axSpA) defined by chronic inflammatory back pain, progressive spinal stiffness, and frequent extra-articular manifestations such as acute anterior uveitis (21%-33%), inflammatory bowel disease (5%-10%), and psoriasis (4%-13%). Management has shifted from non-steroidal anti-inflammatory drugs (NSAIDs) to highly targeted biologic and synthetic disease-modifying antirheumatic drugs (DMARDs). This comprehensive review focuses on the current evidence for biologic and targeted synthetic therapeutics in the management of AS, emphasizing mechanisms of action, regulatory approvals, dosing regimens, and clinical efficacy. Three major therapeutic classes are identified: two biologic DMARD classes, comprising tumor necrosis factor-alpha (TNF-α) inhibitors and interleukin-17 (IL-17) inhibitors, and the targeted synthetic DMARDs, namely, the Janus kinase-signal transducer and activator of transcription (JAK-STAT) inhibitors. TNF inhibitors (adalimumab, infliximab, etanercept, golimumab, certolizumab pegol) typically achieve Assessment of Spondyloarthritis International Society 40% improvement (ASAS40) rates of 40%-58% at 12-24 weeks versus 13%-24% with placebo, and maintain clinical benefit in many patients over 5-8 years. IL-17 inhibitors (secukinumab, ixekizumab, bimekizumab, brodalumab, netakimab) yield broadly similar ASAS40 responses (30%-50% versus 10%-20% placebo) and are particularly useful in patients with concomitant psoriasis with substantially reduced risk of tuberculosis reactivation. JAK inhibitors (tofacitinib, upadacitinib) represent the newest class, offering oral administration with ASAS40 responses of 40%-52% versus 13%-26% for placebo in both biologic-naïve and biologic-experienced AS, though cardiovascular safety considerations necessitate careful patient selection. Therapeutic selection should consider comorbidities (uveitis favors TNF monoclonal antibodies; psoriasis favors IL-17 inhibitors), safety profile, route of administration, and sequencing after non-steroidal anti-inflammatory drug failure. Understanding these pharmacological distinctions enables personalized therapeutic decisions based on the specific molecular pathology and risk profile of the individual patient.

Upadacitinib as an Effective Rescue Therapy in a Case of Adalimumab-Refractory Perifolliculitis Capitis Abscedens et Suffodiens.

Gan Yu-Ting YT, Yan Shi S, Xie Wei-Na WN, Liu Yi Y et al.

Cross-Sectional Analysis of Biologic Use in the Treatment of Veterans With Hidradenitis Suppurativa.

Wendland Zachary Z, Rypka Katelyn K, Greenlund Lindsey L, Herzog Claire C et al.

Biologic medications, such as adalimumab, secukinumab, and bimekizumab, are currently the only medications approved by the US Food and Drug Administration for the treatment of hidradenitis suppurativa (HS). Low rates of biologic use in HS have been reported, with significant differences in prescription patterns by sex, race, and age. However, no studies have analyzed these metrics in the Veterans Health Administration (VHA). This study evaluated HS therapy in the VHA and potential disparities in biologic prescription patterns for patients. This retrospective cross-sectional analysis used VHA data from January 1, 2011, to December 31, 2021. Biologic prescriptions, including adalimumab and infliximab, were analyzed across varying patient demographics and characteristics. In VHA, 29,483 individuals had ≥ 1 diagnosis of HS, of whom 5.2% were prescribed ≥ 1 biologic (adalimumab or infliximab). Most patients diagnosed with HS were White (60.6%), men (75.3%), and obese (59.3%) and had prior or current tobacco use (73.5%). An age-dependent reduction in the odds of being prescribed a biologic in patients with HS (P < .001) was observed. Obesity (body mass index ≥ 30) significantly increased the odds of biologic prescription (P < .001). Biologic use in patients with HS was relatively low but higher or within the same range as previous studies. Understanding biologic prescription patterns offers potential to identify and improve access to underserved HS populations.