NAPLEX Question of the Week: Monoclonal Antibodies

This week's question focuses on one of the highest prescribed and dispensed monoclonal antibodies in clinical practice.

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BT is a 55 year old male with a PMH of rheumatoid arthritis. His current medications include methotrexate 20mg PO weekly. He recently has had an increase in symptoms leading his physician to prescribe Humira. Which of the following is true regarding patient counseling and monitoring for BT? Select all that apply.


A. Humira requires refrigeration prior to use but can be stored at room temperature for up to 14 days

B. Humira should be dosed weekly for rheumatoid arthritis

C. Patients taking Humira are able to receive live vaccinations

D. Taking Humira can put you at increased risk of serious infections leading to hospitalization such as tuberculosis or infections due to opportunistic pathogens

E. Humira should be administered subcutaneously










Answers: A, D, E




Answer A is correct. Humira (adalimumab) requires refrigeration prior to administration. It can be stored at room temperature for up to 14  days and should be discarded if not used within those 14 days. 


Answer B is false. While there are many indications for Humira, in RA the dosing is every OTHER week. Most indications for Humira required every OTHER week dosing.


Answer C is false because patients receiving Humira cannot receive live vaccines per the package insert.


Answer D is correct as there is a black box warning for Humira that states you are at increased risk of serious infection leading to hospitalization or death. There is a second black box warning for malignancy such as lymphoma. 


Answer E is correct as you dose Humira subcutaneously. Some monoclonal antibodies may also be dosed intravenously. 

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.