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Withhold Biologic Infection — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisWithhold Biologic InfectionSCE Rheumatology

A 60-year-old woman with rheumatoid arthritis is treated with adalimumab. She develops a large skin abscess with surrounding cellulitis and fever, requiring hospital admission, incision and drainage, and intravenous antibiotics. What is the most appropriate management of her adalimumab?

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Correct answer: E — Withhold adalimumab and restart after the infection has clinically resolved

The best answer is E. Fever, hospital admission, intravenous antibiotics and surgical drainage establish a serious active bacterial infection. The UK adalimumab SmPC states that adalimumab should be discontinued when a new serious infection or sepsis develops and appropriate antimicrobial treatment given until the infection is controlled. It may subsequently be reintroduced after clinical resolution and appropriate review. Continuing adalimumab, even at a reduced dose, could impair infection control. High-dose prednisolone is not a safe substitute because glucocorticoids also increase infection risk. A single successfully treated infection does not automatically require permanent withdrawal, although recurrent or unusually severe infections should prompt reassessment of the biologic strategy and individual risk factors.

Reference: Humira 40 mg solution for injection in pre-filled pen, UK Summary of Product Characteristics, sections 4.2 and 4.4, text revised 6 February 2026. https://www.medicines.org.uk/emc/product/7986/smpc