Humira, also known by its generic name adalimumab, is used to treat inflammatory conditions in adults and sometimes children. While extremely effective, Humira can affect your immune system and it's important to understand the potential side effects. Let's take a look at what you should know.
Humira belongs to a group of drugs known as TNF alpha inhibitors, which target tumor necrosis factor (TNF), a protein in the body that causes inflammation. If you're healthy, your body blocks extra TNF in your blood naturally, but if you have an inflammatory condition TNF can build up. Inhibiting TNF’s action can help reduce inflammation and disease progression. TNF inhibitors are used to treat:
Most medications have side effects, ranging from the commonly seen to the rare. Not all side effects happen to everyone, but it's vital when you start a new medication to know what's more likely to impact you.
Before Starting Humira
In the case of Humira, we're talking about a drug that affects the immune system, which means you can be more susceptible to infections. Because of this, before you start Humira you should let your health care provider know if you have:
signs of other infections, such as skin sores, chills, sweats, body aches, cough, bloody mucus, skin sores, diarrhea, or constant fatigue
plans to travel, in case you're at risk for contact infections from other parts of the world
tuberculosis (Humira can lead to the reactivation of latent TB)
hepatitis B (Humira can also cause a recurrence of hepatitis B or cause it to get worse)
numbness or tingling
a nerve-muscle disorder or a family history of one, such as Guillain-Barre syndrome or multiple sclerosis
While some milder side effects of Humira go away as your body adjusts to the medication, others are more urgent and require attention from health care providers. Let's take a look.
Humira has been associated with the worsening of cardiovascular symptoms in those who have heart failure, as well as in new heart problems for those without a history. For those with heart failure, it's recommended that health care providers consider treatments other than TNF alpha inhibitors, which obstruct the activity of pro-inflammatory cytokines. Cytokines are proteins that send signals to the immune system in order to regulate the body's response to infection. TNF inhibitors block cytokines that exacerbate inflammatory conditions, such as IBD and RA, but TNF inhibitors can also exacerbate heart failure, especially in higher doses. For those taking Humira, heart problems have been reported, such as:
arrhythmia: irregular heartbeat, which can cause damage to the brain and other organs, as well as lead to stroke, heart attack, if untreated
pericardial effusion: the buildup of too much fluid in the sac around the heart, which can put too much pressure on it and affect how the heart works
tachycardia: a heartbeat that's over 100 beats/minute. This isn't always a problem in itself, but can lead to issues such as heart failure or strokes.
Researchers recommend that patients be evaluated based on cardiovascular risk before a TNF inhibitor is prescribed. If you're taking Humira and you experience any of the following, consult a health care provider as soon as possible:
signs of high blood pressure, such as a severe headache, dizziness, fainting, or vision changes
The relationship between lymphoma (cancers that start in the lymph nodes) and Humira is tricky to assess. As it stands, there seems to be no causal relationship between cancer and biologics, or drugs targeting specific parts of the immune system to treat disease. It appears that up to 4 years of use of Humira, which is considered short-term, is safe and doesn't increase one's risk of developing lymphoma. At the same time, it's recommended that doctors continue to monitor patients, especially those who have an increased risk of lymphoma, due to:
age: Most cases of lymphoma occur in those aged 60 and older.
a family history: Those with a first degree relative (parent, sibling, child) who have had lymphoma are at higher risk of developing it.
a weakened immune system: If you've had an organ transplant, are infected with HIV, or were born with a condition that has left you with a deficient immune system, you may be more likely to develop lymphoma.
Autoimmune disorders such as lupus, celiac disease, and rheumatoid arthritis leave people more vulnerable to lymphoma.
viruses that transform lymphocyte DNA: Lymphocytes are immune cells made in the bone marrow. They help kill tumor cells and control immune responses, but some viruses, like Epstein–Barr and human herpesvirus 8, can infect lymphocyte cells and transform them into cancer cells.
Infections that cause the immune system to be constantly active, such as hepatitis C, can lead to some types of lymphoma.
using Humira along with other drugs, particularly azathioprine or 6-mercaptopurine, which are used to treat active Crohn's Disease or ulcerative colitis. A rare form of lymphoma known as hepatosplenic T-cell lymphoma (HSTCL) has been found in young men/male teenagers, although cases in women and older adults have also been documented.
Humira may increase the risk of skin cancer, especially basal cell (the most common form of skin cancer) and squamous cell (another common type, which can be aggressive). If you're taking Humira, it's advised that you consult a health care provider if you find an open sore or a bump that doesn't heal.
If you’re taking Humira you must be aware that it can impair your ability to fight infection, which leaves you vulnerable to serious infection and reactivation of latent infections. If you're taking Humira along with other drugs that also suppress your immune system, such as corticosteroids or chemotherapeutics, you're even more susceptible to infection.
You may be at risk for fungal infections that impact the internal organs, such as invasive candidiasis, aspergillosis, mucormycosis, cryptococcosis, and histoplasmosis.
There is evidence that Humira can reactivate certain viruses, such as varicella zoster virus (VZV), which causes chickenpox and shingles; cytomegalovirus (CMV), a common virus that usually doesn't cause problems in people with strong immune systems; viral chronic hepatitis B, which impacts the liver; and rare forms of tuberculosis.
Urinary tract infections (UTIs) can also occur in Humira users. UTIs are resolved with antibiotics, but treatment should be sought quickly so the infection does not cause other serious health problems. Not everyone with a UTI has symptoms, but they can include:
a strong urge to urinate that doesn't go away
a burning feeling when urinating
urinating often, and passing small amounts of urine
Pancytopenia is a condition in which the amounts of red and white blood cells and platelets are lower than normal, resulting in:
purple or red spots on the skin
Pancytopenia is a problem forming blood stem cells in the bone marrow, caused by infection, pregnancy, chemotherapy, genetic, bone marrow and autoimmune disorders, toxins, and certain medications, such as Humira. (Source, Source)
Multiple Sclerosis (MS)
Multiple sclerosis is a condition in which the immune system attacks the protective sheath that covers the nerve fibers, leading to communication problems between the brain and the body. Health care providers are urged to be cautious when prescribing Humira or other anti-TNF drugs to patients with a family history of MS and/or autoimmune disorders, because Humira-induced MS has occurred. (Source, Source)
As mentioned above, Humira has been linked to the recurrence of hepatitis B, and to cases of hepatotoxicity, or the injury/impairment of the liver due to exposure to chemicals that aren't naturally produced by the body. These cases have been rare with Humira, but it's recommended that patients be tested for hepatitis B, and those who have it should be given an oral antiviral agent. If a patient develops a syndrome similar to hepatitis B while taking Humira, it might not stop as soon as they stop taking the drug and further treatment might be necessary. (Source)
It is possible to have a serious allergic reaction to Humira. Consult a health care provider immediately if you have any of these symptoms after getting a Humira injection:
a severe rash, hives (swollen red patches of skin)
Some prescription drugs, including Humira, can cause drug-induced lupus (DIL), a condition that resembles the autoimmune disease lupus. Symptoms of DIL may include:
muscle and joint pain, sometimes with swelling
fatigue, fever, and other flu-like symptoms
pain or discomfort from serositis, an inflammation of the serous membranes lining the lungs and heart
Drug-induced lupus usually arises within several months of using a particular drug and resolves within a few weeks of discontinuing it. Most people don't have severe complications, but it's important that DIL is addressed quickly. The type of DIL associated with TNF alpha inhibitors, known as anti-TNF-alpha-induced lupus (ATIL), is uncommon and is not yet well understood.
There are drugs you should not take while you're using Humira, because they can either increase side effects or limit the efficacy of the treatment. Humira can interact with:
live vaccines, which use weakened forms of disease-causing viruses. These include measles, mumps, rubella, chickenpox, and yellow fever. Live vaccines are usually avoided in patients with autoimmune conditions. Humira can suppress your immune system, so if you're being treated with it you should consult your health care provider before getting any of these vaccines.
Arava (leflunomide). When Arava and Humira are used together, they can actually increase the risk of side effects that target bone marrow, so you're more likely to develop anemia, infections, or bleeding problems.
Because Humira can be very expensive, doesn’t work for everyone, and may stop working even if it seems effective at first, there are other options that might be used instead.
If you have a mild or moderate form of disease, it's possible your treatment will involve methotrexate before switching to or adding a TNR alpha inhibitor. Methotrexate is a conventional disease modifying anti-rheumatic drug (DMARD) that decreases inflammation and slows the progression of disease by changing the way your immune system works.
Humira is a biologic DMARD, meaning it targets specific molecules on cells of the immune system, joints, and joints fluids. Other kinds of DMARD include:
Biosimilars (Amjevita, Erelzi, Inflectra) are based on biologics, but are less expensive.
JAK inhibitors (Jakafi, Olumiant, Xeljanz) inhibit the activity of Janus kinase enzymes that are involved in inflammation and autoimmunity. JAK inhibitors are relatively new and still require research to evaluate long-term safety.
Humira comes with many side effects, some rare, some of which go away with time, and others that may show up after long-term use. Since Humira is an immunosuppressant, it can interfere with your body's ability to fight infection. It's imperative that you give your health care provider all the information you know about your own and your family's medical history, since genetics can play a role in certain side effects, such as those that impact the heart and nervous system. If you’re taking Humira, pay attention to your body, and don't hesitate to contact your health care provider with questions and concerns. Lastly, remember that your nutrition and lifestyle makes a difference in your condition expression and quality of life. Whether or not you take Humira, you can always add more nutrients to your diet and prioritize hydration, sleep, stress management, and movement. If you’re looking to make changes to your nutrition and lifestyle for your autoimmune health but don’t know where to start, WellTheory provides personalized, whole-body coaching for individuals with autoimmunity. Learn more about the membership here.