Deskripsi
Combining adalimumab with cyclosporine produces substantial additive immunosuppression, increasing the risk of serious opportunistic infections, lymphoma, and other immunosuppression-related malignancies.
Mekanisme
Adalimumab blocks TNF-alpha, impairing macrophage-dependent defence against intracellular pathogens; cyclosporine inhibits T-cell activation via calcineurin inhibition, further blunting adaptive immunity. The combination suppresses both innate and adaptive immune responses.
Signifikansi Klinis
Post-marketing data and registry studies report markedly elevated rates of serious infections (tuberculosis reactivation, invasive fungal infections, PML) with biologic + CNI combinations.
Penatalaksanaan
Avoid combination unless a compelling clinical indication exists; screen for latent tuberculosis and hepatitis B before initiating; monitor for signs of infection; do not administer live vaccines during therapy.