Adalimumab (Simlandi)
Simlandi (adalimumab) is a biologic medicine that helps the pain and swelling of arthritis.
Simlandi is used to treat Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Juvenile Inflammatory Arthritis, Psoriasis, Crohn’s Disease, and other types of arthritis. It may also be used to treat other diseases outside of rheumatology.
Simlandi works by blocking Tumor Necrosis Factor (TNF), a type of signalling protein (called a cytokine), that is involved in systemic inflammation. Simlandi belongs to a class of similar medications called Anti-Tumor Necrosis Factor agents.
Simlandi may be prescribed in combination with other rheumatology medications like methotrexate.
Biosimilar
Simlandi is a type of medicine that is called a biosimilar. A biosimilar is a type of biologic medication that is designed to be identical to an existing biologic medication, but is created using a different process.
Simlandi is a biosimilar of Humira. Both medications are known by the same generic name: adalimumab. Biosimilars are often cheaper than the original medication.
Taking Simlandi
Simlandi is available as a subcutaneous (under the skin) injection in one of two forms that can be taken at home: as a pre-filled syringe, and as an autoinjector (pen).
Simlandi usually takes about 2 weeks before patients start to feel its effects. It may take 12 weeks to feel the effect of this medicine.
The standard dose of each injection is 40 mg. It is usually taken every other week, but it can be prescribed every week to some patients.
Watch our video to learn how inject Simlandi at home:
Learn how to inject subcutaneous injectionsLearn how to inject autoinjectorsSubcutaneous injections (under the skin injections) are easy to do compared to other types of injections. A small needle pokes just under the skin to deliver medicine into the “fatty tissue” below.
The manufacturer of Simlandi offers a support program to Canadian patients that are prescribed the medication:
Patient support program enrolment formsImportant Tests and Risks
Simlandi can make it a bit harder for people to fight off infections. People taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
Patients should coordinate with their doctor to stop treatment before any surgery. It can be re-started once things have healed and there’s no sign of infection. Most patients stop the medication two to four weeks before surgery. It can be restarted 10-14 days after the surgery as long as there is no sign of infection.
Patients should discuss all vaccinations with their doctor because some (live vaccines) are not advisable to get while taking Simlandi.
It is important to get a TB (tuberculosis) skin test and a chest x-ray before starting treatment.
Patients who are taking Simlandi should get occasional blood tests as requested by their doctor to keep track of their arthritis and make sure that blood counts are ok.
Science
In some people with arthritis, a signalling protein (cytokine) called Tumor Necrosis Factor (TNF) is present in the blood and joints in excessive amounts where it increases inflammation (pain and swelling).
Simlandi is another type of protein called a monoclonal antibody that works as a Tumor Necrosis Factor blocker. It binds to Tumor Necrosis Factor and prevents it from working. Normally Tumor Necrosis Factor would bind to Tumor Necrosis Factor receptors and cause inflammation.
In blocking Tumor Necrosis Factor, Simlandi suppresses the body’s immune system. Though this suppression can make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system and control arthritis.
Safety
People taking Simlandi should talk to their doctor if they are concerned about any side effects.
MORE COMMON side-effects include:
- Mild skin reaction at the injection site (itchiness, redness, and mild swelling).
- Nausea, abdominal pain
- Headache
- Rash
- Upper respiratory tract infections (such as sinusitis).
RARE side-effects include:
- Infection – There is an increased risk of serious infections while taking Simlandi. Any infections or fevers should be taken seriously and reviewed by a doctor.
- Nervous System – There have been rare reports of some patients developing disorders that affect the nervous system while taking Simlandi, such as: multiple sclerosis, seizures, or inflammation of the nerves of the eye. Fortunately, these reports are exceedingly rare.
- Heart – Patients should make sure their doctor knows if they have congestive heart failure as Simlandi can make it worse.
- Blood Counts – Simlandi can cause a drop in the numbers of white blood cells (which are needed to fight infection) or red blood cells (which carry oxygen). This is very rare and it is unusual for this to be a serious problem.
- Malignancy – When used for long periods of time, Simlandi may be associated with a small increased risk of cancer, however, the data is not entirely clear.
How to minimize the side-effects of Simlandi:
- Patients should take Simlandi as prescribed by their doctor.
Patients who should NOT be taking Simlandi (adalimumab) include:
- Patients who have had a previous serious allergic reaction to this medication
- Possibly patients who have cancer or have had a past history of certain cancers
- Patients who have severe or uncontrolled congestive heart failure
- Patients who have Lupus or multiple sclerosis
- Patients with active infections (such as tuberculosis)
- Patients already taking a medication that is also a “TNF blocker”
Patients should discuss all vaccinations with their doctor as some vaccines are not advisable while taking Simlandi.
Patients who are planning for surgery should tell their doctor.
Patients taking Simlandi (adalimumab) should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons for people taking Simlandi to call their doctor include:
- Fever or possible infection
- If another doctor has prescribed antibiotics to fight an infection
- Before having surgery
- Pregnancy
- Planning to get any vaccinations
- Rash
Patients who become pregnant while taking Simlandi should notify their doctor.
Pregnancy and medicationsVideo
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Simlandi in this short video:
Resources
DIN
- 02523949 (SC) - Prefilled Syringe (40 mg/0.4 mL)
- 02523957 (SC) - Autoinjector (40 mg/0.4 mL)
- 02523965 (SC) - Prefilled Syringe (80 mg/0.8 mL)