Tumour
necrosis factor (TNF) plays an important role in the pathogenesis of immune-mediated inflammatory diseases (
IMIDs). TNF inhibition results in down-regulation of abnormal and progressive inflammatory processes, resulting in rapid and sustained clinical remission, improved quality of life and prevention of target organ damage.
Adalimumab is the first fully human
monoclonal antibody directed against TNF. In this article, we review the role and cost effectiveness of
adalimumab in the treatment of
IMIDs in adults and children. The efficacy and tolerability of
adalimumab has been demonstrated in patients with a wide range of inflammatory conditions, leading to regulatory approval in
rheumatoid arthritis (RA),
psoriatic arthritis (PsA), plaque
psoriasis,
inflammatory bowel diseases (
Crohn's disease,
ulcerative colitis, paediatric
Crohn's disease, and intestinal Behçet's disease),
ankylosing spondylitis (AS),
axial spondyloarthritis (SpA) and
juvenile idiopathic arthritis. The major tolerability issues with
adalimumab are class effects, such as
injection site reactions and increased risk of
infection and
lymphoma. As with all anti-TNF agents,
adalimumab is immunogenic, although less than
infliximab, and some patients receiving long-term
adalimumab will develop anti-drug
antibodies, causing a loss of response. Comparisons of its clinical utility and cost effectiveness have shown it to be a valid treatment choice in a wide range of patients. Recent data from Italian economic studies show the cost effectiveness of
adalimumab to be below the threshold value for health care interventions for most indications. In addition, analysis of indirect costs shows that
adalimumab significantly reduces social costs associated with RA, PsA, AS,
Crohn's disease and
psoriasis. The fact that
adalimumab has the widest range of approved indications, many often presenting together in the same patient due to the common pathogenesis, may further improve the utility of
adalimumab. Current clinical evidence shows
adalimumab to be a valuable resource in the management of
IMIDs. Further research, designed to identify patients who may benefit most from this drug, will better highlight the role and cost-effectiveness of this versatile
TNF inhibitor.