Adalimumab is a disease modifying, biological drug used to treat rheumatoid arthritis, psoriatic arthritis, Crohns disease, ulcerative colitis and Hidradenitis suppurativa. It is given by sub cutaneous injection.
It has a molecular weight 148,000. Poor oral bioavailability and relative infant dose 0.12% ( well below 10% regarded as compatible).
Adalimumab is a recombinant human monoclonal TNF antibody that binds specifically to TNF- α.
It is likely that any small amounts in milk are destroyed in the baby’s gut. Two infants of women who
took adalimumab 40 mg subcutaneously during lactation were followed until 14.5 and 15 months of
age. No adverse reactions were found in the infant to be attributed to exposure of the drug in breast
milk. Both infants were reported to have met all developmental milestones (Fritzsche 2012).
BNF however states that it should be avoided by breastfeeding mothers because the manufacturer
advises it should be avoided for at least 5 months after last dose. This is not based on evidence.
Adalimumab is compatible with breastfeeding due to poor bio-availability and hence low-level absorption by the infant. It should be avoided in the first few days post partum when the gaps between the cells are wide open to facilitate transfer of immunoglobulins.
If it is used in pregnancy live vaccines should be avoided in the baby – normally rotavirus because immunity may be compromised. If not used in pregnancy when the rotavirus is given, the breastfeeding mother needs to wear gloves for 2 weeks to avoid picking up the live viral fragments shed in faeces. This alert card may be useful to have within the red book to remind professionals.
References
- Wasan SK, Kane SV. Adalimumab for the treatment of inflammatory bowel disease. Expert
- Rev Gastroenterol Hepatol. 2011 Dec;5(6):679-84.
- Fritzsche J, Pilch A, Mury D, Schaefer C, Weber-Schoendorfer C. Infliximab and adalimumab
- use during breastfeeding. J Clin Gastroenterol 2012;46(8):718-19.
- https://www.ncbi.nlm.nih.gov/books/NBK501392/
- https://e-lactancia.org/breastfeeding/adalimumab/product/
