WARNING: SERIOUS INFECTIONS and MALIGNANCY
SERIOUS INFECTIONS
Patients treated with adalimumab products, including Adalimumab-adaz, are at increased risk for
developing serious infections that may lead to hospitalization or death. Most patients who
developed these infections were taking concomitant immunosuppressants such as methotrexate or
corticosteroids.
Discontinue Adalimumab-adaz if a patient develops a serious infection or sepsis.
Reported infections include:
-
Active tuberculosis (TB), including reactivation of latent TB. Patients with TB have
frequently presented with disseminated or extrapulmonary disease. Test patients for latent TB
before Adalimumab-adaz use and during therapy. Initiate treatment for latent TB prior to
Adalimumab-adaz use
-
Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis,
aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other
invasive fungal infections may present with disseminated, rather than localized, disease.
Antigen and antibody testing for histoplasmosis may be negative in some patients with active
infection. Consider empiric anti-fungal therapy in patients at risk for invasive fungal
infections who develop severe systemic illness
-
Bacterial, viral, and other infections due to opportunistic pathogens, including Legionella
and Listeria
Carefully consider the risks and benefits of treatment with Adalimumab-adaz prior to initiating
therapy in patients with chronic or recurrent infection.
Monitor patients closely for the development of signs and symptoms of infection during and
after treatment with Adalimumab-adaz, including the possible development of TB in patients who
tested negative for latent TB infection prior to initiating therapy.
MALIGNANCY
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent
patients treated with TNF blockers including adalimumab products. Post-marketing cases of
hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in
patients treated with TNF-blockers including adalimumab products. These cases have had a very
aggressive disease course and have been fatal. The majority of reported TNF blocker cases have
occurred in patients with Crohn's disease or ulcerative colitis and the majority were in
adolescent and young adult males. Almost all these patients had received treatment with
azathioprine or 6-mercaptopurine (6–MP) concomitantly with a TNF blocker at or prior to
diagnosis. It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or
a TNF blocker in combination with these other immunosuppressants.