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!style="text-align:left;"|Synonyms
|ADL,<br />D2E7,<br />adalimumab-adaz,<br />adalimumab-adbm,<br />adalimumab-atto<ref name="[1]" />
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!style="text-align:left;"|Type
== Medical Use and TDM ==
The drug is supplied as a solution for injection with a pH of 5.2. Current available dosage forms are 40 mg/0.8 mL, 40 mg/0.4 mL, 20 mg/0.4 mL and 10 mg/0.2 mL single-use prefilled syringe. There also exist prefilled pens of 40 mg/0.8 mL and 40 mg/0.4 mL.<ref name=”[4]”>Medsafe (2012). Humira solution for injection: Data Sheet. Accessed on 6 November 2018, at [http://www.medsafe.govt.nz/Medicines/SearchResult.asp ''http://www.medsafe.govt.nz/Medicines/SearchResult.asp''].</ref> It ADL is administered once every week or every other week. The target steady state trough concentration is between 5 and 8 µg/mL.
In current practices, a patient can be classified as a non-reponder, when the concentration of adalimumab is at a normal range, but the patient has no decreased disease activity, the patient can be classified as non-responding. A switch to a different medicine could be beneficialis often advised. When serum levels of adalimumab are too low, the underlying cause, either non-compliance or ADAb, is investigated. If the concentration is not extremely low, an increase of dosage can be considered.
Measurements of adalimumab levels are not routinely done. Therapeutic drug monitoring (TDM) is the practice of measuring the concentration of a specific drug in the bloodstream with the aim of using this data to optimize the individual dosing schemes of patients. TDM could provide a means to optimize the treatment with adalimumab. The introduction of a biosensor for adalimumab as a means for TDM would allow for better drug monitoring. It gives the possibility to detect non-responders in an early stage of treatment or to optimize dosing strategies. For patients with too high serum levels, dosage reduction to obtain serum levels between 5 and 8 µg/mL could be beneficial for the patient as the expensive drug is used more optimally. As ADAb can be the cause of the lower adalimumab serum levels, measurement of ADAb with a biosensor is also a possibility. However, as adalimumab can interfere with an assay that measures ADAb, measurement of adalimumab itself is to be prefered.<ref name=”[22]”>Pouw, M.F. et al. (2015). Key findings towards optimising adalimumab treatment: the concentration–effect curve. ''Annals of the rheumatic diseases, 74''(3), 513–518. [https://doi.org/10.1136/annrheumdis-2013-204172 ''doi:10.1136/annrheumdis-2013-204172'']</ref>
To determine the trough levels of adalimumab, the samples must be taken within 24 hours prior to the drug administration.<ref name=”[27]”>MabTrack level adalimumab (2018). Leaflet ''MabTrack level adalimumab''. Sanquin.</ref>
These assays are sandwich-type assays with enzymatic labelling, expect except for the RIDA®QUICK ADM Monitoring and Quantum Blue® Adalimumab, which are based on lateral flow immunoassays. Mabtrack by Sanquin uses polystyrene microtiter wells with immobilized TNF-specific mouse monoclonal antibodies. These bind recombinant TNF. The adalimumab that is present in the sample bind binds to the bound TNF on the microtiter plate and a an adalimumab/TNF/anti-TNF complex is formed. Next, a monoclonal ADAb labeled with horseradish peroxidase is added which binds to the complex. A substrate solution leads to the formation of a colored product, proportional to the amount of adalimumab present in the sample.<ref name=”[27]”>MabTrack level adalimumab (2018). Leaflet ''MabTrack level adalimumab''. Sanquin.</ref> The Adalimumab ELISA and LISA-TRACKER Adalimumab both have immobilized TNF-⍺ on the surface of the microwell plate. While the apDia Adalimumab ELISA makes use of ADAb conjugated with peroxidase to form a TNF-⍺/adalimumab/conjugated-ADAb complex, the LISA-TRACKER uses anti-human IgG biotinylated antibodies to form the complex, whereafter horseradish peroxydase labelled with streptavidin is added that binds to the complex.<ref name=”[28]”>apDia Adalimumab ELISA (2016). Leaflet ''apDia Adalimumab ELISA.'' apDia.</ref><ref name=”[29]”>LTA002 LISA-TRACKER Adalimumab (2017). Leaflet ''LTA002 LISA-TRACKER Adalimumab''. Theradiag.</ref>
== Numbers ==
