Psoriatic arthritis: Recommendations for the use of adalimumab

  • Indications: moderate/severe psoriatic arthritis; moderate/severe psoriasis; adult and juvenile rheumatoid arthritis (as young as 4 y); ankylosing spondylitis; and adult Crohn's disease
  • Dosing: 40 mg every other wk subcutaneously
  • Response: ACR20 at wk 12 is 58%
  • Toxicities: Moderately painful injection site reactions are noted; Rare reports of serious infections (ie, tuberculosis and opportunistic infections) and malignancies; There are rare reports of drug-induced, reversible side effects including lupus without renal or CNS complications, cytopenia, MS, and exacerbation of and new onset of CHF.
  • Baseline monitoring: PPD is required; LFT, CBC, and hepatitis profile
  • Ongoing monitoring: Periodic history and physical examination are recommended while on treatment; Consider a yearly PPD, and periodic CBC and LFT. 
  • Pregnancy category B

Level of Evidence: 1 Strength of Recommendation: A

Read more about these recommendations on efficacy

In a phase III study of 313 PsA patients, adalimumab showed significant benefit for the treatment of psoriatic arthritis.26  Adalimumab was administered subcutaneously at 40 mg every other week or weekly.  In the double blinded portion of the study at 24 weeks, 57% of patients receiving adalimumab 40 mg every other week achieved ACR20 response compared with 15% of patients receiving placebo (p<.001).  At week 24, the ACR 50 and ACR 70 response rates were 39% and 23% for adalimumab treated patients compared to 6% and 1% for patients receiving placebo, respectively (p < 0.001).  The response rate did not differ between patients taking adalimumab in combination with methotrexate (50% of patients) and those taking adalimumab alone, although the numbers of patients in each cohort were too small to have adequate statistical power.  Mean improvement in enthesitis and dactylitis was greater for patients receiving adalimumab than placebo, but this result did not achieve statistical significance. Using a modified Sharp score, radiographic progression of hand and foot joint disease was significantly inhibited by adalimumab. Mean change in the modified Sharp score was -0.2 for patients receiving adalimumab and 1.0 for patients receiving placebo (p<.001).  Mean change in the Health Assessment Questionnaire (HAQ) was -0.4 for adalimumab patients and -0.1 for placebo patients (p<.001).

Navigate section 2 of the psoriasis guideline

Citation note

When referencing this guideline in a publication, please use the following citation: Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008 May;58(5):851-64.

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