Adalimumab

What it is

Adalimumab is a laboratory-made (recombinant) fully human IgG1 monoclonal antibody given by subcutaneous injection, usually every other week or weekly. It is a large protein, not a tablet, and its mean terminal half-life is about two weeks. Several biosimilar versions are marketed under different suffixed names. It is approved in the US for nine conditions, from rheumatoid arthritis to non-infectious uveitis.

What the research says

Where randomised trials are recorded here, adalimumab produces large relative improvements, but the absolute benefit varies several-fold by condition. In rheumatoid arthritis added to methotrexate, 67.2% reached an ACR20 response versus 14.5% on placebo. In Crohn's disease maintenance, 36% stayed in remission at 56 weeks versus 12% on placebo. In ulcerative colitis the absolute gain was much smaller: 17.3% in remission at 52 weeks versus 8.5%. In hidradenitis suppurativa, response was 41.8% versus 26.0% in one trial and 58.9% versus 27.6% in the other. It did not work for hand osteoarthritis in a randomised trial. For five of its nine approved uses - juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis and non-infectious uveitis - this write-up records only the label's indication wording and no trial effect sizes at all; that is a gap in what we gathered, not evidence that the drug works as well, or as poorly, in those conditions. The harms are the reason for its boxed warning: serious infections ran at 4.3 per 100 patient-years versus 2.9 on control across 39 trials, and a meta-analysis of anti-TNF antibodies in rheumatoid arthritis found a number needed to harm of 59 for one extra serious infection and 154 for one extra malignancy. A Cochrane overview of 163 trials found biologics as a class raised total adverse events and TB reactivation but did not show a statistically significant increase in serious infections, lymphoma or heart failure.

Evidence grade: Well established.

How it works

Drug class: Tumour necrosis factor alpha (TNF-alpha) blocker; recombinant fully human IgG1 monoclonal antibody (biologic DMARD)

Adalimumab is an antibody that locks onto TNF-alpha, one of the body's main inflammation-signalling proteins, and stops it reaching its receptors on cells. TNF is elevated in the joint fluid of people with rheumatoid and related arthritis and in psoriasis plaques, so blocking it damps down inflammation. Because TNF is also part of normal defence against infection and tumour control, blocking it is what produces the drug's main risks as well as its benefit. The label states the link between these laboratory effects and the clinical benefit is not fully understood. (Source 1)

Boxed warning

WARNING: SERIOUS INFECTIONS AND MALIGNANCY

(Source 2)

What it is used for

• In the ARMADA trial, adding adalimumab 40 mg every other week to ongoing methotrexate produced an ACR20 response in 67.2% versus 14.5% on methotrexate plus placebo at 24 weeks, an absolute difference of about 53 percentage points (roughly 2 people treated per extra responder). ACR70, a much stricter threshold, was reached by 26.9% versus 4.8%. Evidence: established. (Source 3)
• In CHARM, among patients who had already responded to open-label induction, 36% on adalimumab 40 mg every other week were still in remission at week 56 versus 12% on placebo (absolute difference 24 percentage points, about 4 people treated per extra remission). This is a maintenance result in selected responders, not an induction result in everyone. Evidence: established. (Source 4)
• In ULTRA 2, clinical remission at week 52 was 17.3% on adalimumab versus 8.5% on placebo, an absolute difference of 8.8 percentage points (about 11 people treated per extra remission). Benefit in patients who had already failed another anti-TNF drug was smaller and not significant at week 8. The label adds that effectiveness has not been established in patients who lost response to or could not tolerate TNF blockers. Evidence: established. (Source 5)
• The two PIONEER phase 3 trials found clinical response at week 12 in 41.8% versus 26.0% (PIONEER I) and 58.9% versus 27.6% (PIONEER II). Secondary outcomes improved significantly in PIONEER II only. Both trials were funded by the manufacturer. Evidence: established. (Source 6)
• These are separate approved indications on the US label, each with its own trial programme and its own dosing. We did not re-examine the pivotal trial for each one in this slice, so the absolute effect sizes for these five uses are not reported here; the label is recorded as a regulatory position with its date. Evidence: established. (Source 7)
• A randomised, double-blind, placebo-controlled multicentre trial in patients with painful hand osteoarthritis who had not responded to analgesics and NSAIDs found 35.1% on adalimumab versus 27.3% on placebo achieved at least 50% pain reduction at week 6 (RR 1.12, 95% CI 0.82 to 1.54, p=0.48), with no difference on any secondary endpoint. Evidence: not-supported. (Source 8)

Interactions

• Live vaccines (label): Live vaccines should not be given while on adalimumab, because blocking TNF weakens the immune response and a live organism in a vaccine could cause infection. (Source 9)
• Anakinra, abatacept and other biologic DMARDs or TNF blockers (clinical trial): Combining adalimumab with these other biologics raised the rate of serious infections without any extra benefit in rheumatoid arthritis trials, so the combination is not recommended. (Source 10)
• Warfarin, cyclosporine, theophylline and other narrow-therapeutic-index CYP450 substrates (theoretical): Long-standing inflammation suppresses liver CYP450 enzymes; damping the inflammation with adalimumab can let those enzymes recover, which may change the blood levels or effect of drugs they metabolise. The label recommends monitoring when adalimumab is started or stopped. This is a theoretical mechanism applied to a real monitoring recommendation rather than a measured interaction study. (Source 9)
• Methotrexate (pharmacokinetic study): Methotrexate reduced how fast the body clears adalimumab, but the label states this does not call for a dose change to either drug. The two are routinely used together. (Source 10)
• Supplements, foods, grapefruit and alcohol (label): We found no documented interaction between adalimumab and any dietary supplement, food or alcohol. The drug-interactions section of the US label names only four categories - methotrexate, other biologic products, live vaccines and CYP450 substrates - and lists no food, supplement or alcohol interaction. Mechanistically this is expected: adalimumab is an injected antibody that is broken down like other proteins rather than metabolised by the enzymes that supplements and grapefruit affect. Absence of a documented interaction is not the same as proof of safety. (Source 10)

Stopping it

• There is no physical dependence or withdrawal syndrome. The documented problem with stopping is disease flare. A 2024 systematic search and review of 49 studies found flare rates of 33-87% in rheumatoid arthritis after stopping adalimumab or another TNF inhibitor, 17-63% with tapering versus 28-82% with abrupt stopping in juvenile idiopathic arthritis, and recapture of control after restarting in 80-100% of rheumatoid arthritis cases. (Source 11)
• The same review's overall conclusion was that tapering produced less flare than stopping abruptly across rheumatoid arthritis, spondyloarthropathy and juvenile idiopathic arthritis, and that restarting usually regained control. The review also notes the studies varied widely in design and follow-up, and that few looked at adalimumab on its own. (Source 12)
• The label's own position is that adalimumab should be stopped if a serious infection or sepsis develops, and that drug levels of narrow-therapeutic-index medicines may need monitoring when adalimumab is stopped as well as when it is started. (Source 2)

What goes wrong

Across 39 controlled adalimumab trials the rate of serious infection was 4.3 per 100 patient-years versus 2.9 on control, an excess of about 1.4 serious infections per 100 patient-years. (Source 13)

• Official position, Moderate certainty.
• Size: 7,973 adalimumab-treated and 4,848 control-treated subjects.
• Who: adults with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis, hidradenitis suppurativa or uveitis.
• How long: controlled portions of the trials.
• Result: Serious infections 4.3 vs 2.9 per 100 patient-years; infections included pneumonia, septic arthritis, prosthetic and post-surgical infections, erysipelas, cellulitis, diverticulitis and pyelonephritis.
• Funding: manufacturer's pooled trial data as recorded on the label published Feb 06, 2026.

the rate of serious infections was 4.3 per 100 patient-years in 7973 HUMIRA-treated subjects versus a rate of 2.9 per 100 patient-years in 4848 control-treated subjects

Active tuberculosis was reported at 0.20 per 100 patient-years across 52 adalimumab trials, mostly within the first eight months of treatment. (Source 14)

• Official position, Moderate certainty.
• Size: 24,605 adalimumab-treated subjects across 52 trials.
• Who: adults across all the approved indications.
• How long: controlled and uncontrolled trials.
• Result: Active TB 0.20 per 100 patient-years globally and 0.05 per 100 patient-years in the US and Canadian subgroup; PPD conversion 0.09 per 100 patient-years; serious opportunistic infections 0.05 per 100 patient-years; some fatal.
• Funding: manufacturer's pooled trial data as recorded on the label.

the rate of reported active tuberculosis was 0.20 per 100 patient-years and the rate of positive PPD conversion was 0.09 per 100 patient-years

A meta-analysis of anti-TNF antibody trials in rheumatoid arthritis found one extra serious infection for every 59 patients treated and one extra malignancy for every 154, with malignancy risk higher at higher doses. (Source 15)

• Meta-analysis, Moderate certainty.
• Size: 9 trials; 3,493 patients on anti-TNF antibody and 1,512 on placebo.
• Who: adults with rheumatoid arthritis, treated for 12 weeks or more.
• How long: 3 to 12 months for infections, 6 to 12 months for malignancy.
• Result: Pooled odds ratio for malignancy 3.3 (95% CI 1.2-9.1); for serious infection 2.0 (95% CI 1.3-3.1); number needed to harm 154 (95% CI 91-500) for one extra malignancy and 59 (95% CI 39-125) for one extra serious infection.
• Funding: independent academic meta-analysis; the authors supplemented published data by direct contact with principal investigators and industry sponsors.

the number needed to harm was 154 (95% CI, 91-500) for 1 additional malignancy within a treatment period of 6 to 12 months. For serious infections, the number needed to harm was 59 (95% CI, 39-125) within a treatment period of 3 to 12 months.

Injection site reactions affected 20% of adalimumab-treated patients versus 14% on placebo, and 7% versus 4% stopped treatment because of adverse reactions in the rheumatoid arthritis trials. (Source 16)

• Official position, Moderate certainty.
• Size: placebo-controlled trials; the RA discontinuation figure covers studies RA-I to RA-IV.
• Who: adults in placebo-controlled adalimumab trials.
• How long: double-blind placebo-controlled periods.
• Result: Injection site reactions 20% vs 14%; discontinuation for adverse reactions in RA 7% vs 4%; commonest reasons for stopping were clinical flare reaction (0.7%), rash (0.3%) and pneumonia (0.3%)
• Funding: manufacturer's pooled trial data as recorded on the label.

In placebo-controlled trials, 20% of subjects treated with HUMIRA developed injection site reactions (erythema and/or itching, hemorrhage, pain or swelling), compared to 14% of subjects receiving placebo.

Adalimumab induced new positive antinuclear antibodies in 12% of rheumatoid arthritis trial patients versus 7% on placebo, and two of 3,046 developed a lupus-like syndrome that improved after stopping. (Source 17)

• Official position, Low certainty.
• Size: RA controlled trials; 3,046 adalimumab-treated subjects for the lupus-like syndrome count.
• Who: adults with rheumatoid arthritis who were ANA-negative at baseline.
• How long: to week 24.
• Result: Positive ANA at week 24 in 12% vs 7%; 2 of 3,046 developed clinical signs suggestive of new-onset lupus-like syndrome, which improved on discontinuation; no lupus nephritis or CNS involvement.
• Funding: manufacturer's pooled trial data as recorded on the label.

In the rheumatoid arthritis controlled trials, 12% of subjects treated with HUMIRA and 7% of placebo-treated subjects that had negative baseline ANA titers developed positive titers at week 24.

What the evidence supports

Adding adalimumab to methotrexate in active rheumatoid arthritis produced an ACR20 response in 67.2% of patients versus 14.5% on methotrexate plus placebo. (Source 3)

• Randomized trial, Moderate certainty.
• Size: 271 patients randomised.
• Who: adults with active rheumatoid arthritis despite a stable dose of methotrexate.
• How long: 24 weeks.
• Result: ACR20 at week 24: 47.8% (20 mg), 67.2% (40 mg), 65.8% (80 mg) vs 14.5% placebo (P < 0.001); ACR50 55.2% (40 mg) vs 8.1%; ACR70 26.9% (40 mg) vs 4.8% (P < 0.001). For the 40 mg dose, absolute difference in ACR20 about 53 percentage points, roughly 2 treated per extra responder.
• Funding: industry-funded (the trial of the manufacturer's product; funding not stated in the abstract)

An ACR20 response at week 24 was achieved by a significantly greater proportion of patients in the 20-mg, 40-mg, and 80-mg adalimumab plus MTX groups (47.8%, 67.2%, and 65.8%, respectively) than in the placebo plus MTX group (14.5%) (P < 0.001).

In Crohn's disease, among patients who had already responded to induction, 36% on adalimumab every other week were in remission at 56 weeks versus 12% on placebo. (Source 4)

• Randomized trial, Moderate certainty.
• Size: randomised responders from a larger induction cohort.
• Who: adults with moderate to severe Crohn's disease who had responded to open-label adalimumab induction.
• How long: 56 weeks.
• Result: Remission (CDAI below 150) at week 26: 40% (eow), 47% (weekly) vs 17% placebo; at week 56: 36%, 41% vs 12% (P < .001). Absolute difference at week 56 for eow dosing 24 percentage points, about 4 treated per extra remission.
• Funding: industry-funded (Abbott); funding not stated in the abstract.

The percentage of randomized responders in remission was significantly greater in the adalimumab 40-mg eow and 40-mg weekly groups versus placebo at week 26 (40%, 47%, and 17%, respectively; P < .001) and week 56 (36%, 41%, and 12%, respectively; P < .001).

In ulcerative colitis, remission at 52 weeks was 17.3% on adalimumab versus 8.5% on placebo - a real but small absolute benefit, with about 11 people treated per extra remission. (Source 5)

• Randomized trial, Moderate certainty.
• Size: 494 patients.
• Who: adults with moderate to severe ulcerative colitis on concurrent corticosteroids or immunosuppressants.
• How long: 52 weeks.
• Result: Remission at week 8: 16.5% vs 9.3% (P = .019); week 52: 17.3% vs 8.5% (P = .004). Serious adverse events 12% in both arms; serious infections 1.6% vs 1.9%.
• Funding: industry-funded (Abbott ULTRA 2 programme); funding not stated in the abstract.

Overall rates of clinical remission at week 8 were 16.5% on adalimumab and 9.3% on placebo (P = .019); corresponding values for week 52 were 17.3% and 8.5% (P = .004).

What the evidence does not support

In ulcerative colitis patients who had already received an anti-TNF drug, adalimumab did not significantly increase remission at week 8. (Source 5)

• Randomized trial, Low certainty.
• Size: prior anti-TNF subgroup of 494 patients.
• Who: adults with moderate to severe ulcerative colitis previously treated with anti-TNF agents.
• How long: 8 and 52 weeks.
• Result: Remission at week 8: 9.2% vs 6.9% (P = .559); at week 52: 10.2% vs 3% (P = .039). Subgroup analysis, underpowered.
• Funding: industry-funded.

Among patients who had previously received anti-TNF agents, rates of remission at week 8 were 9.2% on adalimumab and 6.9% on placebo (P = .559)

Adalimumab was not better than placebo for pain in hand osteoarthritis that had not responded to analgesics and NSAIDs. (Source 8)

• Randomized trial, Moderate certainty.
• Size: 85 randomised, 78 evaluated on the primary outcome.
• Who: patients with painful hand osteoarthritis refractory to analgesics and NSAIDs; mean age 62 years, 85% women.
• How long: 6 weeks for the primary outcome, monitored 6 months.
• Result: At least 50% pain reduction at week 6 in 35.1% vs 27.3% (RR 1.12, 95% CI 0.82 to 1.54, p=0.48); no statistical difference on any secondary endpoint; adverse event rates similar.
• Funding: not stated in the abstract; the trial is registered as NCT00597623.

Limit of this finding: The source sentence has an unbalanced bracket - it opens '(RR 1.12 (95% CI 0.82 to 1.54; p=0.48)' and never closes the outer one. We have kept the quote exactly as published rather than tidy it. The numbers themselves are complete and consistent: the interval spans 1 and p is 0.48, so this is a null result.

At W6, 35.1% in the adalimumab group versus 27.3% in the placebo group had a pain reduction ≥50% (RR 1.12 (95% CI 0.82 to 1.54; p=0.48). There were no statistical differences for all secondary end points.

The same Cochrane overview cautions that its signals were inconsistent across outcomes and that long-term safety data for biologics are lacking. (Source 18)

• Review of reviews, Low certainty.
• Size: 163 RCTs with 50,010 participants.
• Who: patients treated with one of nine biologics including adalimumab, any indication except HIV/AIDS.
• How long: median six months.
• Result: No consistent pattern across adverse outcomes; the review calls for registry and large-database evidence for longer-term safety.
• Funding: Cochrane review (independent)

Some biologics had a statistically higher association with certain adverse outcomes compared to control, but there was no consistency across the outcomes so caution is needed in interpreting these results.

Where the evidence is mixed

In hidradenitis suppurativa, weekly adalimumab produced clinical response in 41.8% versus 26.0% in one phase 3 trial and 58.9% versus 27.6% in the other, but secondary outcomes improved significantly in only one of the two. (Source 6)

• Randomized trial, Moderate certainty.
• Size: 307 patients (PIONEER I) and 326 patients (PIONEER II)
• Who: patients with moderate to severe hidradenitis suppurativa.
• How long: 12 weeks (period 1), 24 further weeks (period 2)
• Result: Week 12 response 41.8% vs 26.0% (P=0.003) and 58.9% vs 27.6% (P<0.001); absolute differences 15.8 and 31.3 percentage points (about 6 and 3 treated per extra responder). Serious adverse events 1.3% vs 1.3% and 1.8% vs 3.7%.
• Funding: industry-funded (AbbVie)

Patients receiving adalimumab had significantly greater improvement than the placebo groups in rank-ordered secondary outcomes (lesions, pain, and the modified Sartorius score for disease severity) at week 12 in PIONEER II only.

A Cochrane overview of 163 randomised trials found biologics as a class increased total adverse events and tuberculosis reactivation, but did NOT show a statistically significant increase in serious adverse events, serious infections, lymphoma or congestive heart failure. (Source 19)

• Review of reviews, Low certainty.
• Size: 163 RCTs with 50,010 participants plus 46 extension studies with 11,954 participants.
• Who: patients with any condition except HIV/AIDS treated with one of nine biologics including adalimumab.
• How long: median six months for the randomised trials.
• Result: Total adverse events OR 1.19 (95% CI 1.09 to 1.30), NNTH 30 (21 to 60); withdrawals for adverse events OR 1.32 (1.06 to 1.64), NNTH 37 (19 to 190); TB reactivation OR 4.68 (1.18 to 18.60), NNTH 681 (143 to 14706). Data were limited for TB reactivation, lymphoma and congestive heart failure.
• Funding: Cochrane review (independent); the review states data were limited for the rarest outcomes.

The rate of serious adverse events, serious infections, lymphoma, and congestive heart failure were not statistically significantly different between biologics and control treatment.

Where the research disagrees

Whether anti-TNF treatment measurably increases serious infections and cancer

• Bongartz and colleagues, JAMA 2006 meta-analysis of anti-TNF antibody trials in rheumatoid arthritis, meta-analysis of 9 randomised trials, 3,493 treated and 1,512 placebo patients: The pooled odds ratio for malignancy was 3.3 (95% confidence interval [CI], 1.2-9.1) and for serious infection was 2.0 (95% CI, 1.3-3.1). (Source 15)
• Singh and colleagues, Cochrane overview and network meta-analysis 2011, across nine biologics and all indications, overview of 163 randomised trials with 50,010 participants, median six months: The rate of serious adverse events, serious infections, lymphoma, and congestive heart failure were not statistically significantly different between biologics and control treatment. (Source 19)

How much

• Reference intake: Dosing is set by the prescriber and differs by condition. As a position, the US label (version published Feb 06, 2026) gives 40 mg subcutaneously every other week for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, with the option of 40 mg weekly or 80 mg every other week in rheumatoid arthritis patients not taking methotrexate. The same label requires testing for latent tuberculosis before starting and periodically during treatment. (Source 20)
• Upper limit: There is no conventional upper intake limit for a biologic. As a position, the highest regimen stated on the label for rheumatoid arthritis is 40 mg every week or 80 mg every other week; the induction and maintenance regimens for inflammatory bowel disease, hidradenitis suppurativa and paediatric use are set out separately on the label by indication and body weight. (Source 20)
• Studied: ARMADA randomised 271 rheumatoid arthritis patients to adalimumab 20 mg, 40 mg or 80 mg subcutaneously every other week, or placebo, on top of stable methotrexate. (Source 3)
• Studied: CHARM used open-label induction with adalimumab 80 mg at week 0 and 40 mg at week 2, then randomised responders to 40 mg every other week, 40 mg weekly, or placebo through week 56. (Source 4)
• Studied: ULTRA 2 gave adalimumab 160 mg at week 0, 80 mg at week 2, then 40 mg every other week in 494 patients with ulcerative colitis. (Source 5)
• Studied: The PIONEER trials gave 40 mg weekly in period 1 for 12 weeks, then reassigned patients to weekly or every-other-week dosing or placebo for 24 weeks. (Source 6)
• Studied: The null hand osteoarthritis trial gave only two 40 mg subcutaneous injections 15 days apart - a much shorter exposure than in the approved indications. (Source 21)

A common belief, and what the research shows

The belief: Adalimumab works about as well for any inflammatory condition.

What the research shows: The absolute benefit differs several-fold between its approved uses, and in some conditions it does nothing. In rheumatoid arthritis added to methotrexate, "An ACR20 response at week 24 was achieved by a significantly greater proportion of patients in the 20-mg, 40-mg, and 80-mg adalimumab plus MTX groups (47.8%, 67.2%, and 65.8%, respectively) than in the placebo plus MTX group (14.5%) (P < 0.001)." In ulcerative colitis the same drug gave remission in far fewer people: "corresponding values for week 52 were 17.3% and 8.5% (P = .004)" - a gain of under 9 percentage points. And in hand osteoarthritis a randomised trial found "There were no statistical differences for all secondary end points." and no significant difference on the primary endpoint either. For five further approved uses this write-up carries only the label's indication wording and no effect sizes at all, which is a gap in the evidence gathered here rather than a sign the drug performs the same in those conditions.

Questions and answers

What is it?

Adalimumab is an injected biologic medicine: a laboratory-made human antibody that targets TNF-alpha, a protein the body uses to signal inflammation. It is given under the skin, typically every other week, and is sold as Humira and as several biosimilars. It is not a tablet and cannot be taken by mouth, because it is a protein that would be digested. (Source 1)

What does it do in the body?

It mops up TNF-alpha before it can reach receptors on cells, which turns down the inflammatory signal driving conditions such as rheumatoid arthritis, Crohn's disease and psoriasis. TNF is raised in the joint fluid of people with these arthritides and in psoriasis plaques. The same blockade reduces the immune system's ability to contain infection and, possibly, abnormal cells, which is the source of its main risks. (Source 1)

Is it good or bad for you?

Both, and the balance depends on the condition and the person. The benefit is large in rheumatoid arthritis (ACR20 67.2% versus 14.5%) and in Crohn's maintenance (36% versus 12% in remission at 56 weeks), smaller in ulcerative colitis (17.3% versus 8.5%), and absent in hand osteoarthritis. Against that, serious infections ran at 4.3 versus 2.9 per 100 patient-years across the trial programme, a meta-analysis estimated one extra serious infection per 59 patients treated, and the drug carries a boxed warning for serious infections and malignancy including lymphoma in children and adolescents. (Source 22)

How do you get more of it?

Adalimumab is a prescription biologic; the only way to receive it is by prescription and injection, and the regimen is set by the prescriber for the specific condition. There is no food, supplement or lifestyle route to getting more of it. The label states, as a position, that the adult dosage for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is 40 mg every other week, with other regimens by indication. (Source 20)

If it is harmful, what reduces it?

When adalimumab causes harm the documented response is to stop it, and the drug then clears slowly - its mean terminal half-life is about two weeks, so effects persist for a month or more after the last dose. The boxed warning states the drug should be discontinued if a serious infection or sepsis develops. Where it has been stopped for remission rather than harm, a systematic review found tapering produced fewer flares than abrupt stopping. (Source 2)

Why might someone be low in it or missing it?

Adalimumab is a medicine, not something the body makes, so nobody is naturally low in it. What does vary is how much of an injected dose stays active: some people make antibodies against adalimumab itself (anti-adalimumab antibodies), which can lower drug levels and reduce the response. Methotrexate taken alongside slows clearance, raising levels. (Source 23)

Which whole foods contain it or feed it?

No whole food contains adalimumab or raises its level. It is a recombinant antibody manufactured in cell culture and given by injection. We found no food or supplement interaction documented for it - the label's drug-interactions section names only methotrexate, other biologics, live vaccines and CYP450 substrates. (Source 9)

What happens if you do not have it?

Most people never need adalimumab. For someone with one of the conditions it is approved for, not taking it means relying on other treatment, and the trials show what that looks like: in Crohn's maintenance only 12% of placebo patients were still in remission at 56 weeks versus 36% on adalimumab; in rheumatoid arthritis 14.5% on methotrexate plus placebo reached an ACR20 response versus 67.2%. It also means avoiding the drug's excess infection and malignancy risk. (Source 13)

How can you test for it?

Two kinds of test exist. Before and during treatment, testing for latent tuberculosis is required by the label, because TNF blockade can reactivate it. Separately, serum adalimumab concentrations and anti-adalimumab antibodies can be measured to work out why someone is not responding; the label cautions that these assays differ in sensitivity and are not comparable between studies, so a single number should not be over-interpreted - with the older ELISA, antibodies could only be detected when drug levels were below 2 mcg/mL. (Source 23)

References

1. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
2. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information - BOXED WARNING: SERIOUS INFECTIONS AND MALIGNANCY, part 1 of 3 (SERIOUS INFECTIONS). 2026. Read the source
3. Arthritis and rheumatism. Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial.. 2003. PMID 12528101, DOI 10.1002/art.10697. Read the source
4. Gastroenterology. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial.. 2007. PMID 17241859, DOI 10.1053/j.gastro.2006.11.041. Read the source
5. Gastroenterology. Adalimumab induces and maintains clinical remission in patients with moderate-to-severe ulcerative colitis.. 2012. PMID 22062358, DOI 10.1053/j.gastro.2011.10.032. Read the source
6. The New England journal of medicine. Two Phase 3 Trials of Adalimumab for Hidradenitis Suppurativa.. 2016. PMID 27518661, DOI 10.1056/nejmoa1504370. Read the source
7. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information - Section 1 INDICATIONS AND USAGE (1.1 to 1.6). 2026. Read the source
8. Annals of the rheumatic diseases. Adalimumab in patients with hand osteoarthritis refractory to analgesics and NSAIDs: a randomised, multicentre, double-blind, placebo-controlled trial.. 2015. PMID 24817417, DOI 10.1136/annrheumdis-2014-205348. Read the source
9. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
10. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
11. Pediatric rheumatology online journal. Approaches and outcomes of adalimumab discontinuation in patients with well-controlled inflammatory arthritis: a systematic search and review.. 2024. PMID 39734203, DOI 10.1186/s12969-024-01046-3. Read the source
12. Pediatric rheumatology online journal. Approaches and outcomes of adalimumab discontinuation in patients with well-controlled inflammatory arthritis: a systematic search and review.. 2024. PMID 39734203, DOI 10.1186/s12969-024-01046-3. Read the source
13. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
14. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
15. JAMA. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials.. 2006. PMID 16705109, DOI 10.1001/jama.295.19.2275. Read the source
16. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
17. DailyMed, U.S. National Library of Medicine (label version published Feb 06, 2026). HUMIRA (adalimumab) kit [AbbVie Inc.] - FDA prescribing information. 2026. Read the source
18. The Cochrane database of systematic reviews. Adverse effects of biologics: a network meta-analysis and Cochrane overview.. 2011. PMID 21328309, DOI 10.1002/14651858.cd008794.pub2. Read the source
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