Humira is a prescription medication used to treat several autoimmune conditions, including rheumatoid arthritis, Crohn's disease, and ankylosing spondylitis. If you are living with an autoimmune disease, your health care provider may prescribe Humira as part of your treatment plan. (Source)

Without a doubt, Humira can help manage symptoms of certain autoimmune diseases. However, like any pharmaceutical drug, it carries a risk of side serious effects. In this article, we’ll discuss 10 long-term side effects of Humira you should know about before you start taking it. 

What Is Humira?

Humira is the brand name for a pharmaceutical drug called adalimumab, a type of medication known as a “biologic.” A biologic drug is derived from a variety of natural sources, such as human, animal, or microbial sources, and may be produced using biotechnology methods. (Source)

Adalimumab is a monoclonal antibody, a genetically modified protein that acts like a natural antibody and targets a single antigen. Adalimumab keeps an inflammatory signaling compound called tumor necrosis factor alpha (TNF-α) from binding to its receptor on cells in your body. TNF-α is produced by white blood cells and serves a number of vital purposes in the body, but research suggests inappropriate or excessive TNF-α signaling can promote autoimmunity. By blocking the activity of this signaling compound, Humira may reduce inflammatory symptoms associated with autoimmunity. (Source, Source) 

Humira is administered subcutaneously, via an injection beneath the skin. The frequency of the injections depends on the condition that it is being used to treat. (Source) 

What Conditions Does Humira Treat?

Humira is approved for the treatment of the following autoimmune conditions:

• rheumatoid arthritis
• ankylosing spondylitis
• Crohn’s disease
• ulcerative colitis
• hidradenitis suppurativa
• juvenile idiopathic arthritis
• plaque psoriasis
• psoriatic arthritis
• uveitis

(Source)

10 Potential Long-Term Side Effects to Know Before You Start Humira

Humira injections can cause acute side effects, including itching or redness near the injection site and allergic reactions. These acute reactions require immediate medical attention. However, in this article, we will focus on discussing Humira's long-term side effects. (Source) 

It is critical to note that Humira has a “black box warning” due to the risk of serious infection associated with this kind of treatment. This is assigned by the U.S. Food and Drug Administration (FDA) and is the strongest safety-related warning a medication can have. If you and your health care provider are contemplating having you try Humira, you should be aware of this warning before getting started. (Source, Source)

Let’s discuss 10 of the potential long-term side effects of Humira that you should know before you start. 

1. Increased Risk of Infection

Tumor necrosis factor is a normal part of your immune system. When it is present and active at a normal level, it helps protect your body against infections. When it is inhibited, it renders your body more susceptible to infections, including opportunistic infections from pathogens that would not normally cause symptoms. One of Humira's most serious side effects — an increased risk of bacterial, viral, and fungal infections — is related to this blockade of TNF-α activity. In fact, the black box warning for Humira specifically highlights the increased risk of infection. (Source, Source, Source) 

Humira is linked to an increased risk of the following infections:

• pneumonia, a respiratory infection
• appendicitis
• urinary tract infections
• gastroenteritis, an intestinal infection
• herpes zoster viral infection, also known as shingles
• reactivation of a previous tuberculosis infection. Screening for latent or dormant tuberculosis infection is typically carried out before Humira is prescribed. If a latent infection is detected, it should be treated before taking Humira.
• cellulitis, a bacterial infection of the skin
• candidiasis, an overgrowth of the opportunistic yeast Candida
• aspergillosis, an invasive fungal infection 
• cytomegalovirus, a common virus that is often asymptomatic but may cause infections such as mononucleosis or hepatitis

(Source)

2. Increased Risk of Certain Cancers 

Tumor necrosis factor, as its name suggests, plays a role in regulating tumor growth. Therefore, researchers hypothesize that blocking TNF-α activity may increase the risk of certain cancers. Humira currently has a black box warning for its effects on cancer risk. The primary cancers linked to adalimumab are lymphoma, a cancer of the lymphatic system, and non-melanoma skin cancer. Less common cancers that have occurred in people on Humira include melanoma and cancers of the breast, colon, prostate, and lung. (Source, Source) 

3. Cardiovascular Complications

The effects of anti-TNF medications on the cardiovascular system are not fully understood. However, emerging research suggests anti-TNF drugs like adalimumab may have cardiovascular side effects. Certain TNF receptors called TNFR2 receptors on heart cells appear to protect the heart. Blocking the binding of TNF to these receptors may have detrimental effects, leading to cardiovascular complications such as congestive heart failure. (Source, Source, Source) 

4. Liver and Gallbladder Complications

Research suggests that adalimumab elevates several liver enzymes, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT). Elevated liver enzymes often indicate inflammation and damage to liver cells. Humira may provoke liver damage by triggering an immune response within the liver. Humira has also been found to trigger cholecystitis, a painful swelling and inflammation of the gallbladder, and cholestasis, a slowing or stalling of bile flow from the liver. (Source, Source, Source, Source) 

In addition, adalimumab may reactivate hepatitis B, a viral infection that attacks the liver. This reaction only occurs in people on Humira who previously had the hepatitis B virus. Hepatitis B can lead to long-term health problems, including liver damage, liver failure, and liver cancer. (Source, Source) 

Symptoms of liver or gallbladder complications may include:

• pain and tenderness in your upper right abdomen near your rib cage
• jaundice, a yellowing of your skin or the whites of your eyes
• fatigue
• elevated liver enzymes on bloodwork run by your health care provider, such as elevated GGT, AST, or ALT

(Source)

5. Allergic Reactions

Allergic reactions to Humira can occur with an initial dose, manifesting as injection site reactions such as rash, redness, itchiness, or swelling. However, initial allergic injection site reactions may later cause the immune system to respond with a systemic allergic response. In addition, Humira may also cause a delayed hypersensitivity reaction, a reaction that typically occurs more than 12 hours after exposure to an allergen. A delayed hypersensitivity reaction to Humira may cause skin rashes, fatigue, and headaches. (Source, Source, Source, Source) 

If you experience an allergic reaction to Humira, contact your health care provider to discuss acute management of the reaction and determine whether an alternative course of treatment is needed. 

6. Changes in Numbers of Red and White Blood Cells and Platelets

Adalimumab has been reported to cause a condition called pancytopenia, in which there is a decrease in red and white blood cells and platelets in the blood. Pancytopenia can lead to complications such as shortness of breath, pale skin, weakness, dizziness, and bleeding. (Source, Source)  

The type of blood cell change that occurs in pancytopenia when the level of platelets is too low is called thrombocytopenia. Platelets are essential for forming blood clots, and complications of thrombocytopenia include serious bleeding that can, in some cases, become life-threatening. (Source, Source) 

7. New or Worsening Psoriasis

Humira may trigger new psoriasis or provoke existing psoriasis. If you currently have psoriasis or had it in the past, you must discuss this with your health care provider, as they may need to monitor your skin more closely if you take Humira. (Source, Source) 

8. Lupus-Like Syndrome

Humira can trigger a lupus-like syndrome in some, including elevated levels of autoantibodies — immune proteins that attack the body’s own cells and tissues — and symptoms such as joint pain or skin rashes, which are characteristic of lupus. Fortunately, this syndrome is thought to occur only rarely with adalimumab and similar drugs, is usually mild, and the research suggests it resolves when treatment with adalimumab is discontinued. (Source) 

9. Neurologic Reactions

Adalimumab may cause nerve conditions, including demyelination of nerves. Myelin is a layer of protein and fat that forms a sheath around nerves, helping them conduct signals properly throughout the body. Demyelinating conditions damage the myelin sheath, slowing or stopping nerve impulses and causing neurological problems. (Source, Source) 

The mechanism behind why anti-TNF drugs like Humira may cause demyelination is yet to be fully understood. However, one theory suggests these medications may allow self-reactive immune cells to access the nervous system, where they can damage the myelin surrounding nerves. (Source)

10. Weight Gain

Research indicates adalimumab may trigger weight gain in some people, possibly by altering the body's weight regulation “thermostat” in the brain. In addition, people with autoimmune disease may eat less when they’re in pain and struggling with symptoms, and when Humira reduces these symptoms the return of a more normal appetite can result in weight gain. (Source) 

A prospective study found that weight gain in people with inflammatory bowel disease on TNF-suppressing medications, including adalimumab, was modest, with participants gaining about 3 lb over a year. It is important to note that not everyone on Humira gains weight, and other factors besides Humira may affect weight gain in people taking the medication. (Source) 

Alternatives to Humira

While Humira may be helpful for some people with autoimmune disease, it is not your only option for managing autoimmune conditions such as rheumatoid arthritis, ankylosing spondylitis, and Crohn’s disease. Diet and lifestyle changes can significantly ease symptoms of many autoimmune conditions. Be sure to speak with your health care provider before adding any diet or lifestyle adjustments to your routine.

Dietary Changes

Eating a nutritious, anti-inflammatory diet is a powerful way to ease autoimmune symptoms. If you are interested in trying a comprehensive anti-inflammatory diet, the autoimmune protocol (AIP) diet may help! This diet is a modified form of a paleo diet that focuses on nutrient density and eliminates foods that may stimulate the immune system or harm the gut. The AIP diet has been found to improve symptoms and reduce gut inflammation in people with Crohn’s disease and ulcerative colitis. (Source)

If AIP isn’t the right fit for you, you can try making more gradual dietary changes to ease your symptoms. For example, eating more fish may help manage rheumatoid arthritis symptoms by supplying your body with anti-inflammatory omega-3 fatty acids. In addition, consuming more foods that contain anti-inflammatory polyphenols, such as berries and culinary herbs, may alleviate disease activity in inflammatory bowel diseases. (Source, Source)

Curcumin

Curcumin, a bioactive compound found in turmeric root, shows promise for addressing multiple autoimmune conditions. It may alleviate joint swelling, tenderness, and markers of inflammation in rheumatoid arthritis, and reduce disease activity in ulcerative colitis and Crohn’s disease. It is important to select a high quality curcumin supplement and ask your health care provider for guidance on the appropriate dosage for your unique needs. (Source, Source) 

Stress Management 

Chronic stress — unrelenting stress that you can never completely eliminate — hurts your health in many ways, including negatively affecting your immune system. A growing body of research indicates that stress plays an important role in autoimmune disease activity, and that managing stress in healthy ways can improve symptoms. For example, meditation, mindfulness, and yoga may help people with rheumatoid arthritis better manage their symptoms and improve their quality of life. (Source, Source) 

There are many stress management practices to choose from, ranging from meditation to spending time with your pet. Select a stress management practice that resonates with you — the best stress management practice is the one you can engage in consistently! 

Movement

Research shows that staying active can improve symptoms and quality of life in multiple autoimmune conditions. For example, in people with ankylosing spondylitis, just 30 minutes of exercise a day combined with back exercises performed 5 days a week has been shown to improve pain and stiffness. Aerobic exercise improves mobility and pain in people with rheumatoid arthritis. (Source, Source)

The Bottom Line

While Humira can be life-saving for people with autoimmune diseases, it carries a significant risk of long-term side effects. By taking proactive steps to manage the autoimmune disease through diet and lifestyle, you may be less likely to need Humira long-term and thus may be able to avoid these adverse effects. 

Your daily nutrition and lifestyle choices have a powerful influence over your health and, ultimately, the course of the autoimmune disease you’re experiencing. WellTheory’s Care Team can provide you with personalized nutrition and lifestyle support to help you find relief from autoimmune symptoms, so you can feel your best and confidently manage your health.