Vol. 10, Issue 3 (2024)

Background: Advances in rheumatoid arthritis (RA) treatment, including methotrexate and biologic therapies, have shifted treatment recommendations toward disease remission. 
Objective: To evaluate the safety, efficacy, and predictors of response to adalimumab in RA treatment.

Patients and Methods: This open-label clinical trial involved RA patients at Baghdad Teaching Hospital from October 2014 to March 2016. Inclusion criteria were based on the 1987 and 2010 ACR classification and a DAS28 score ≥ 3.3. Out of 111 identified patients, 64 met the inclusion/exclusion criteria and received adalimumab (40 mg subcutaneously every other week) for six months. Baseline demographic and clinical data were collected, and monthly follow-ups were conducted. 
Results: The study population (age 20–62) was predominantly female (87.5%). One-third had prior biologic use, and another third used DMARDS; 67.2% had a history of steroid use. Initially, 75% had highly active disease (DAS28 > 5.1). After six months, 60% shifted to moderate activity, 12% achieved low activity, and 8% reached remission. A significant reduction in DAS28 (≥ 1.2 units) was observed in 73.3%, with 5% showing moderate improvement. Male gender, steroids, and DMARDS were associated with favorable responses, while only steroid use predicted remission. Hemoglobin and WBC counts decreased significantly, while AST and ALT levels increased slightly. Renal function remained unchanged. 
Conclusions: Adalimumab is effective and well tolerated in RA patients, with male gender, steroid use, and DMARDS improving treatment response. Steroid use was the only factor favoring remission.