Understanding Adalimumab

Transcription

1 Understanding Adalimumab Turnberg Building Inflammatory Bowel Disease Service All Rights Reserved Document for issue as handout.

2 What is my treatment? Adalimumab is considered to be effective for the management of severe Crohn s disease. It aims to reduce inflammation in the bowel. How does it work? Adalimumab works with your body s immune system to block an inflammatory agent, TNFalpha (tumour necrosis factoralpha) found in the blood. As part of the immune response, your body naturally produces chemicals, such as TNF-alpha, to help fight infections, temporarily causing inflammation in the affected areas. In Crohn s Disease the body overproduces TNF-alpha. This high concentration of TNFalpha found in the lining of the inflamed intestine is believed to be one of the key triggers of inflammation. Adalimumab is used in patients who have severe Crohn s disease and for whom surgery is not appropriate. Often patients will have tried other medications such as steroids, azathioprine and methotrexate to control their symptoms but have not been able to achieve remission. Evidence suggests that after twelve weeks of receiving the drug, four out of ten people will achieve remission, a further two out of ten people will see an improvement in their symptoms and the remaining four will see no improvement in their condition. Before starting adalimumab Adalimumab will be started by your hospital consultant managing your inflammatory bowel disease. Before commencing the treatment he will consider your medical history and current medications to see if there are any reasons you should not receive adalimumab. Prior to starting adalimumab your consultant will screen you for tuberculosis, this will include having a chest x-ray, and in some cases additional tests may be completed. It is important if have had tuberculosis, or have been in contact with anyone who has had tuberculosis that you tell your doctor. How is adalimumab given Adalimumab treatment should be supervised by a specialist doctor experienced in the diagnosis and treatment of Crohn s Disease. It is given as a subcutaneous injection (injection under the skin). It cannot be taken orally, because the digestive system would destroy the drug. A health care at home company will deliver the treatment to your home, at a time which is convenient to you. A nurse will then attend your home at a convenient time for yourself, and train you, or a friend or family member to inject your treatment. Alternatively, we can arrange for you to come to clinic for your injections if you feel happier. Adalimumab comes in a preprepared solution for injection either in the form of a pre-filled pen or syringe. These come in a pack, which also contains an alcohol pad for wiping the skin before injecting. The injection is usually given under the skin of your thigh or stomach and takes at least 10 seconds if using the pen and about 2-5 seconds for the syringe. The injection must not be given in any area where the skin is reddened, bruised or hard. The site of the injection should also be at least 3cm away from any previous injection sites. Adalimumab is usually given initially in combination with steroids, unless you cannot tolerate them or treatment with them is not appropriate. You may also continue on the other immunosuppressive medication such as azathioprine or methotrexate, that you have been taking whilst starting adalimumab therapy. 1 2

3 What are the side effects? About 1 in 10 patients will experience some adverse reaction to the injection. These are usually mild and recover without requiring any treatment. One of the commonest side effects is pain at the injection site, sometimes with redness, itching and swelling. It may help to remove the drug from the fridge for approximately 15 minutes before using to allow it to warm up to room temperature. You could also apply an ice pack for 2 to 3 minutes to the area you re going to inject before cleansing the skin with alcohol. Some people find inserting the needle quickly with one single motion and then slowly injecting the medicine helps. If your skin hurts or is swollen at the injection site afterwards, you could apply an ice pack or cold damp towel to the area for 10 to 15 minutes every 1 to 2 hours. If you use an ice pack place a light towel between the ice pack and your skin. Other common side effects include: stuffy nose, sinus pain headaches nausea, abdominal pain mouth ulcers rash. You can get reactions to adalimumab for up to five months after the last dose of the treatment as it takes about five months to clear from the body. While most side effects are mild to moderate, some may be serious and require treatment. You must tell your doctor of ANY reaction you get while on the treatment and up to five months after stopping adalimumab. Tell your doctor immediately if you develop any of the following symptoms: severe rash, hives (swollen, red, itchy patches of skin) or other signs of allergic reaction swollen face, hands and feet trouble breathing, swallowing shortness of breath with exertion or upon lying down or swelling of the feet signs and symptoms suggestive of blood disorders such as persistent fever, bruising, bleeding, paleness signs of infection such as fever, fatigue, cough or flu. Chicken pox or shingles If you receive adalimumab and you develop chicken pox or shingles you should contact the IBD helpline as soon as possible. Taking other medications Before you commence adalimumab the specialist nurse will check your medication for interactions. If you commence any new medicines whilst receiving adalimumab you should discuss these with your doctor or specialist nurse. Vaccines You should avoid receiving live vaccines whilst on adalimumab. If you receive a live vaccine you are likely to become unwell. Inactivated vaccines such as the flu vaccine are safe. You should discuss any planned vaccination with your consultant or specialist nurse before having them. 3 4

4 Drinking alcohol It is safe to consume alcohol whilst you on adalimumab. Although we do recommend that this is within national guidelines of 2-3 units per day for a woman and 3-4 units per day for men. Food Food made from unpasteurised milk, such as soft cheese and pate, may be a source of bacteria which could increase your risk of developing infection. Having a baby and breastfeeding There is no evidence to say whether adalimumab is safe during pregnancy or breastfeeding. Therefore we advise you not to conceive or breastfeed whilst you receive adalimumab. You should discuss reliable forms of contraception with your doctor. Follow up care Each time you have adalimumab we ask you to attend either your GP or the medical investigation unit a week prior to your infusion. This will enable us to have your full blood count, urea and electrolyte balance and liver function test checked and to weigh you. The specialist nurse will see you on each infusion, and your consultant will see you 12 weeks after commencing adalimumab. At this review he will assess your response to adalimumab and discuss whether to continue the therapy with you. The consultant may then see you once every six months. What happens if I choose not to accept this treatment? Your consultant will have decided with you that adalimumab is the best way to manage your condition. Sometimes patients are overwhelmed by the information that they are given prior to starting new drug therapy. It is important to us that you make an informed decision about starting therapy and feel that this is the best way to manage your symptoms. If you change your mind or are uncertain about starting adalimumab then you should contact either your consultant or specialist nurse to discuss your options. Are there any alternatives? Unfortunately, treatment options in inflammatory bowel disease are limited. Patients who receive adalimumab usually have severe disease that has not bee controlled with other medication such as azathioprine or methotrexate. If you feel there are alternatives you would like to try or be considered for, you should discuss them with your consultant or specialist nurse. Finally If you have any questions about your medication or your inflammatory bowel disease then please do not hesitate to contact the inflammatory bowel disease service hotline on: or by ibd@srft.nhs.uk 5 6

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